Atherogenic index of plasma is associated with major adverse cardiovascular events in patients with type 2 diabetes mellitus

Liyao Fu,Zhenhua Xing,Shenghua Zhou,Ying Zhou,Jiaxing Sun,Shi Tai,Zhaowei Zhu,Yongjun Wang

doi:10.1186/s12933-021-01393-5

Abstract

BackgroundPrevious studies reported the prognostic value of the atherogenic index of plasma (AIP) in the course of atherosclerosis and other cardiovascular diseases (CVDs). Still, the predictive utility of the AIP is unknown among patients with type 2 diabetes mellitus (T2DM).MethodsThis was a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, which randomized 10,251 patients with long-lasting T2DM. ROC curve analysis was used to determine an optimal threshold for AIP, and the study population was divided into high and low AIP groups. Univariable and multivariable Cox proportional hazards regression analyses were used to determine the association between AIP and primary (major adverse cardiovascular events [MACEs], including nonfatal myocardial infarction, nonfatal stroke, and/or death from cardiovascular causes) and secondary outcomes (all-cause mortality). Stratified analyses were performed to control for the confounding factors.ResultsAIP was an independent risk factor for the prognosis of T2DM (HR = 1.309; 95% CI 1.084–1.581; P = 0.005). The threshold for AIP was determined to be 0.34 in the study population. After adjustments for confounding factors, multivariable analysis showed that AIP was associated with the risk of MACEs (Model 1: HR = 1.333, 95% CI 1.205–1.474, P < 0.001; Model 2: HR = 1.171, 95% CI 1.030–1.333, P = 0.016; Model 3: HR = 1.194, 95% CI 1.049–1.360, P = 0.007), all-cause mortality (Model 1: HR = 1.184, 95% CI 1.077–1.303, P < 0.001), cardiovascular death (Model 1: HR = 1.422, 95% CI 1.201–1.683, P < 0.001; Model 3: HR = 1.264, 95% CI 1.015–1.573, P = 0.036), and nonfatal myocardial infarction (Model 1: HR = 1.447, 95% CI 1.255–1.669, P < 0.001; Model 2: HR = 1.252, 95% CI 1.045–1.499, P = 0.015; Model 3: HR = 1.284, 95% CI 1.071–1.539, P = 0.007). Subgroup stratified analyses showed that AIP might interact with sex, a classical risk factor of cardiovascular events.ConclusionsThis study showed that AIP might be a strong biomarker that could be used to predict the risk of cardiovascular events in patients with T2DM.Trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000620.

Highlights

Atherosclerotic cardiovascular disease (ASCVD) refers to a condition that involves cholesterol buildup in the arteries, often presenting as coronary heart disease, Fu et al Cardiovasc Diabetol (2021) 20:201 cerebrovascular disease, and peripheral artery disease of atherosclerotic origin
Action to Control Cardiovascular Risk in Diabetes (ACCORD) was a 2 × 2 factorial trial aiming to test whether strict control of blood glucose, blood pressure, and lipids could reduce the incidence of cardiovascular diseases (CVDs) in type 2 diabetes mellitus (T2DM) patients
All individuals who participated in this study were T2DM patients between 40 and 79 years of age and who had glycosylated hemoglobin (HbA1c) levels of at least 7.5% and a history of CVD indicated by the anatomical evidence of significant atherosclerosis, albuminuria, left ventricular hypertrophy, or at least two risk factors for cardiovascular diseases

Summary

Introduction

Atherosclerotic cardiovascular disease (ASCVD) refers to a condition that involves cholesterol buildup in the arteries, often presenting as coronary heart disease, Fu et al Cardiovasc Diabetol (2021) 20:201 cerebrovascular disease, and peripheral artery disease of atherosclerotic origin. Type 2 diabetes mellitus (T2DM) has been associated with the early onset of ASCVDs [1]. Diabetic patients typically develop cardiovascular abnormalities with greater severity 14.6 years in advance than those without diabetes mellitus (DM) [2, 3]. Established risk factors for ASCVDs include hypertension and dyslipidemia, which are common in patients with T2DM [1]. Studies showed that patients pre-conditioned with dyslipidemia had dysregulated lipid and glucose metabolism (insulin resistance), resulting in a poorer prognosis of ASCVDs [4]. The incidence of T2DM complications has reduced over the years due to advances in medicine, more than 382 million people in the world currently have diabetes, making them more vulnerable to ASCVD-related disability and deaths [5]. The predictive utility of the AIP is unknown among patients with type 2 diabetes mellitus (T2DM)

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