Lipid-associated CHD risk varies with glucose handling capacity
MedWire News: Dyslipidemia confers an increased risk for incident coronary heart disease (CHD) in people with some, but not all grades of abnormal glucose handling, reveals research.
The finding suggests that the management of cardiovascular risk should differ in people with fasting as opposed to post-load hyperglycemia, say Lei Zhang (University of Helsinki, Finland) and co-authors, writing in Diabetes Research and Clinical Practice.
The researchers examined the impact of dyslipidemia on CHD incidence in people with different glucose-handling capacities. They pooled data from six population-based prospective studies in Finland and Sweden, involving a total of 4818 men and 4269 women aged 25-89 years.
All participants were believed to be free of CHD and diabetes at baseline and the median follow-up duration was 10.2 years. A total of 457 people developed CHD during this time.
Analysis of baseline glucose parameters revealed that 6.8% of the 9087 participants had previously undiagnosed diabetes, 10.8% had isolated impaired glucose tolerance (IGT), 8.8% had isolated impaired fasting glucose (IFG), and 4.7% had both IGT and IFG.
Individuals with hyperglycemia tended to be older and have worse lipid profiles and anthropometric characteristics, and a higher prevalence of hypertension than normoglycemic participants, report the authors.
After adjusting for these and other confounders, the hazard ratios for incident CHD in people with newly diagnosed diabetes were 1.39, 0.57, 1.21, 1.56, and 1.74 for each 1-unit increase in Z-scores of total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, triglycerides (TG), non-HDL cholesterol, and TC to HDL ratio, respectively.
In people with normoglycemia, the multivariate-adjusted hazard ratios were 1.22, 0.71, 1.35, 1.42, and 1.23 for each unit increase in the respective lipid variables.
By contrast, none of the lipid variables were associated with the risk for incident CHD in people with isolated IGT or combined IFG/IGT, and only TC and non-HDL cholesterol predicted CHD risk in people with isolated IFG.
Zhang and co-authors remark: "Our findings show that TC, HDL cholesterol, and non-HDL cholesterol are similarly powerful risk factors for CHD in diabetic as in normoglycemic individuals.
"The findings may imply considering different management strategies in people with fasting or post-load hyperglycemia."
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By Joanna Lyford