Nina Tolonen1, Carol Forsblom1, Ville-Petteri Mäkinen2, Valma Harjutsalo3, Daniel Gordin1, Maija Feodoroff1, Niina Sandholm4, Lena M Thorn1, Johan Wadén1, Marja-Riitta Taskinen5, Per-Henrik Groop6. 1. Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland. 2. Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandDepartment of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CASouth Australian Health and Medical Research Institute, Adelaide, Australia. 3. Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, FinlandDiabetes Prevention Unit, Institute for Health and Welfare, Helsinki, Finland. 4. Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, FinlandAalto University, Espoo, Finland. 5. Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. 6. Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, FinlandBaker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia per-henrik.groop@helsinki.fi.
Abstract
OBJECTIVE: To study the ability of lipid variables to predict incident coronary artery disease (CAD) events in patients with type 1 diabetes at different stages of nephropathy. RESEARCH DESIGN AND METHODS: Patients (n = 3,520) with type 1 diabetes and available lipid profiles participating in the Finnish Diabetic Nephropathy Study (FinnDiane) were included in the study. During a follow-up period of 10.2 years (8.6-12.0), 310 patients suffered an incident CAD event. RESULTS: Apolipoprotein B (ApoB)/ApoA-I ratio was the strongest predictor of CAD in normoalbuminuric patients (hazard ratio 1.43 [95% CI 1.17-1.76] per one SD increase), and ApoB was the strongest in macroalbuminuric patients (1.47 [1.19-1.81]). Similar results were seen when patients were stratified by sex or glycemic control. LDL cholesterol was a poor predictor of CAD in women, normoalbuminuric patients, and patients with HbA1c below the median (8.3%, 67 mmol/L). The current recommended triglyceride cutoff of 1.7 mmol/L failed to predict CAD in normoalbuminuric patients, whereas the cohort median 0.94 mmol/L predicted incident CAD events. CONCLUSIONS: In patients with type 1 diabetes, the predictive ability of the lipid variables differed substantially depending on the patient's sex, renal status, and glycemic control. In normoalbuminuric patients, the ratios of atherogenic and antiatherogenic lipoproteins and lipids were the strongest predictors of an incident CAD event, whereas in macroalbuminuric patients, no added benefit was gained from the ratios. Current treatment recommendations may need to be revised to capture residual CAD risk in patients with type 1 diabetes.
OBJECTIVE: To study the ability of lipid variables to predict incident coronary artery disease (CAD) events in patients with type 1 diabetes at different stages of nephropathy. RESEARCH DESIGN AND METHODS: Patients (n = 3,520) with type 1 diabetes and available lipid profiles participating in the Finnish Diabetic Nephropathy Study (FinnDiane) were included in the study. During a follow-up period of 10.2 years (8.6-12.0), 310 patients suffered an incident CAD event. RESULTS:Apolipoprotein B (ApoB)/ApoA-I ratio was the strongest predictor of CAD in normoalbuminuric patients (hazard ratio 1.43 [95% CI 1.17-1.76] per one SD increase), and ApoB was the strongest in macroalbuminuric patients (1.47 [1.19-1.81]). Similar results were seen when patients were stratified by sex or glycemic control. LDL cholesterol was a poor predictor of CAD in women, normoalbuminuric patients, and patients with HbA1c below the median (8.3%, 67 mmol/L). The current recommended triglyceride cutoff of 1.7 mmol/L failed to predict CAD in normoalbuminuric patients, whereas the cohort median 0.94 mmol/L predicted incident CAD events. CONCLUSIONS: In patients with type 1 diabetes, the predictive ability of the lipid variables differed substantially depending on the patient's sex, renal status, and glycemic control. In normoalbuminuric patients, the ratios of atherogenic and antiatherogenic lipoproteins and lipids were the strongest predictors of an incident CAD event, whereas in macroalbuminuric patients, no added benefit was gained from the ratios. Current treatment recommendations may need to be revised to capture residual CAD risk in patients with type 1 diabetes.
Authors: Anni A V Antikainen; Niina Sandholm; David-Alexandre Trégouët; Romain Charmet; Amy Jayne McKnight; Tarunveer S Ahluwalia; Anna Syreeni; Erkka Valo; Carol Forsblom; Daniel Gordin; Valma Harjutsalo; Samy Hadjadj; Alexander P Maxwell; Peter Rossing; Per-Henrik Groop Journal: Cardiovasc Res Date: 2021-01-21 Impact factor: 10.787
Authors: Juma Alkaabi; Charu Sharma; Javed Yasin; Bachar Afandi; Salem A Beshyah; Raya Almazrouei; Ahmed Alkaabi; Sania Al Hamad; Luai A Ahmed; Rami Beiram; Elhadi H Aburawi Journal: Am J Transl Res Date: 2022-07-15 Impact factor: 3.940
Authors: Fanny Jansson Sigfrids; Lars Stechemesser; Emma H Dahlström; Carol M Forsblom; Valma Harjutsalo; Raimund Weitgasser; Marja-Riitta Taskinen; Per-Henrik Groop Journal: J Intern Med Date: 2021-11-24 Impact factor: 13.068