Hyperlipidemia better than glycemia at predicting CHD risk in diabetes
MedWire News: Hyperlipidemia is a stronger predictor of risk for cardiovascular events than is glycemia in patients with Type 2 diabetes, findings from a major long-term study indicate.
Both dyslipidemia and diabetes are associated with an increased risk for cardiovascular disease.
"However, it remains uncertain whether combined treatment of dyslipidemia, for example as manifested by total cholesterol/high-density lipoprotein [HDL] cholesterol, and glycemia can be performed simultaneously to obtain maximum benefit with regard to the risks of coronary heart disease and cardiovascular disease," note Jan Cederholm (Uppsala University, Sweden) and fellow researchers.
To better understand the relative contributions of dyslipidemia and glycemia to cardiovascular disease risk, Cederholm and team performed an analysis of data collected over 5 years from 22,135 individuals with Type 2 diabetes.
The participants were identified through the Swedish Diabetes Register. All were aged 30-75 years and 15% of had previously suffered some form of cardiovascular disease.
Analysis revealed that the risk for coronary heart disease (CHD) increased by 13% for each standard deviation increase in glycated hemoglobin (HbA1c), and by 31% for each standard deviation increase in the ratio of total to HDL cholesterol, both of which associations were statistically significant.
Similarly, dyslipidemia and diabetes each predicted an increased risk for stroke, cardiovascular disease, and total mortality, but the relationship with dyslipidemia was stronger.
Interestingly, the effect of comorbid diabetes and dyslipidemia was less than additive for CHD risk but additive for risks for stroke, cardiovascular disease, and total mortality.
"The findings here of higher risk increases for fatal/nonfatal CHD with total cholesterol/HDL cholesterol than with HbA1c seem to be in accordance with findings from the UKPDS23 and UKPDS56 studies concerning individuals with newly developed Type 2 diabetes," the authors conclude.
They therefore suggest that "optimal treatment of both HbA1c and the ratio of total to HDL cholesterol is important in order to reduce the risks of cardiovascular disease and mortality in Type 2 diabetes."
The findings are reported in the journal Diabetologia.
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By Philip Ford