Abstract
ObjectiveThis study aimed to identify the association between specific short-chain acylcarnitines and cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM).MethodWe retrieved 1,032 consecutive patients with T2DM who meet the inclusion and exclusion criteria from the same tertiary care center and extracted clinical information from electronic medical records from May 2015 to August 2016. A total of 356 T2DM patients with CVD and 676 T2DM patients without CVD were recruited. Venous blood samples were collected by finger puncture after 8 h fasting and stored as dried blood spots. Restricted cubic spline (RCS) analysis nested in binary logistic regression was used to identify possible cutoff points and obtain the odds ratios (ORs) and 95% confidence intervals (CIs) of short-chain acylcarnitines for CVD risk in T2DM. The Ryan–Holm step-down Bonferroni procedure was performed to adjust p-values. Stepwise forward selection was performed to estimate the effects of acylcarnitines on CVD risk.ResultThe levels of C2, C4, and C6 were elevated and C5-OH was decreased in T2DM patients with CVD. Notably, only elevated C2 was still associated with increased CVD inT2DM after adjusting for potential confounders in the multivariable model (OR = 1.558, 95%CI = 1.124–2.159, p = 0.008). Furthermore, the association was independent of previous adjusted demographic and clinical factors after stepwise forward selection (OR = 1.562, 95%CI = 1.132–2.154, p = 0.007).ConclusionsElevated C2 was associated with increased CVD risk in T2DM.
Highlights
Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease (CVD) alongside other risk factors such as smoking and lipid disorders; in turn, CVD is the most prevalent cause of mortality among people with T2DM [1, 2]
Unlike fat that accumulates in the viscera, subcutaneous fat is negatively correlated with triglycerides (TGs), blood pressure, and atherosclerosis and has a protective effect on atherosclerosis [7]
Acylcarnitine is essential for the transport of fatty acid (FA) into the mitochondria, which are free carnitines combined with coenzyme A (CoA) produced by FA b-oxidation [11,12,13]
Summary
Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease (CVD) alongside other risk factors such as smoking and lipid disorders; in turn, CVD is the most prevalent cause of mortality among people with T2DM [1, 2]. Obesity is a common risk factor for diabetes and its cardiovascular complications and has adverse effects on blood pressure and blood lipid [6]. The body mass index (BMI) does not fully explain the increased risk of CVD in diabetics. Compared with the value of BMI, the metabolism and distribution characteristics of lipids will have different effects on diabetes and CVD. A review indicated that some lean people and obese people have similar risk of cardiovascular complications due to differences in fat distribution [8]. The heart energy of diabetic patients is mainly supplied by the oxidation of fatty acids (FAs) [9]. As a small metabolic molecule, acylcarnitine is a product of FAs involved in heart energy supply [10]. Acylcarnitine is involved in the metabolism of triglycerides, cholesterol, and other lipids, as well as in the process of gluconeogenesis, which can comprehensively reflect the changes of glucose and lipid metabolism in diabetic patients
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