Very low LDL could be protective in diabetic dyslipidemia
medwireNews: Achieving very low levels of low-density lipoprotein (LDL) cholesterol while on statin treatment may reduce the risk for cardiovascular disease (CVD) in people with type 2 diabetes and metabolic dyslipidemia, suggest the results of a large observational study.
Jamal Rana (Kaiser Permanente Northern California, Oakland, USA) and co-researchers found an LDL cholesterol level below 50 mg/dL (1.3 mmol/L) to be associated with the lowest risk for atherosclerotic CVD events in this high-risk subgroup.
Prior to adjustment for confounders, there was no significant association between achieved LDL cholesterol levels and CVD outcomes during an average follow-up of 5.9 years among 19,095 people with type 2 diabetes (average age 63.4 years) who were taking a statin.
All included patients, who were identified in the Kaiser Permanente Northern California integrated healthcare delivery system, had metabolic dyslipidemia, defined as triglyceride levels of at least 150 mg/dL (3.9 mmol/L) and high-density lipoprotein cholesterol levels below 50 mg/dL (1.3 mmol/L) in women and 40 mg/dL (1.0 mmol/L) in men.
“The current study specifically focused on the higher risk subset of those diabetic patients with metabolic dyslipidemia, in whom prevention of atherosclerotic cardiovascular disease events despite receiving statins remains a clinical challenge,” write the researchers in The American Journal of Medicine.
After accounting for confounders including age, sex, smoking status, hypertension, BMI, diabetes duration, glycated hemoglobin levels, and Charlson comorbidity score, people who achieved LDL cholesterol levels below 100 mg/dL (2.6 mmol/L) had a significantly lower CVD risk than those with higher levels.
In particular, people in the lowest LDL cholesterol category of less than 50 mg/dL were 30% less likely to have an atherosclerotic CVD event than those with levels of 100 mg/dL or higher, equating to six fewer events per 1000 person–years.
Rana and team say their findings, although observational, support guideline advice to add non-statins in people who fail to achieve LDL cholesterol goals on a maximum tolerated statin dose. They say more research is needed to determine the optimal pharmacologic approach.
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