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Low-density-lipoprotein cholesterol does not predict cardiac risk
in diabetes
Low-density-lipoprotein cholesterol (LDL-C) level wasn’t a good
predictor of cardiovascular disease in type 1 diabetes, but the
total cholesterol-to-high-density lipoprotein cholesterol (HDL-
C) ratio appeared more reliable, an observational study has
shown. Dr Christel Hero, of Sahlgrenska University Hospital
in Gothenburg, Sweden, and colleagues reported that LDL-C
had modest associations with the development of cardiovascular
disease but no consistent dose response above the 100-mg/dl
threshold for statin treatment in this population (American
Diabetes Association 2014; Abstract 301-OR).
In type 1 diabetes patients already on statins, LDL-C levels
didn’t have any significant link to subsequent cardiovascular
disease in the Swedish National Diabetes Registry data. The
total cholesterol-to-HDL-C ratio had similarly modest links to
cardiovascular disease in patients on or off lipid medications, but
with a consistent rise in risk across categories. Hero added, ‘The
ratio of total cholesterol to HDL-C is a more reliable marker for
risk when considering primary prevention.’
Dr Fernando Ovalle, director of the Comprehensive
Diabetes Centre of the University of Alabama in Birmingham,
commented, ‘The findings emphasised how much remains
unknown about cardiovascular disease in type 1 diabetes. We
made a lot of assumptions and jumped to a lot of conclusions
that the markers of cardiovascular disease and treatments for
prevention of cardiovascular diseases will be the same in type
1 diabetes as in type 2, and that just may not be the case. This
could potentially change how we see the use of statins and the
assessment of cardiovascular risk in general.’
Dr Elizabeth Seaquist, president for medicine and science and
a moderator at the session, cautioned, ‘Don’t toss out LDL-C
in clinical practice just yet.’ Dr Seaquist continued by saying
that LDL-C may not be as strong a predictor for cardiovascular
disease as in type 2 diabetes, as has been suspected from prior
studies, but further research is needed to determine what
to use in the clinic. ‘These patients are still at great risk for
cardiovascular events, and we need to make certain that we’re
doing the right things to prevent that’, she said. ‘It will help us if
we were to do a trial to determine the benefits of lipid-lowering
in type 1 patients.’
This study was published as an abstract and presented at a conference. These
data and conclusions should be considered preliminary until published in a
peer-reviewed journal.
Source:
predict-heart-risk-in-diabetes
