Abstract
BackgroundThe aim of the present study was to identify a threshold for the cholesterol level at which the risk of cardiovascular disease (CVD) begins to increase in people with type 2 diabetes mellitus (DM).MethodsUsing the Korean National Health Insurance Service database, 2,077,135 people aged ≥ 40 years with type 2 DM who underwent regular health checks between 2009 and 2012 were included. Subjects with previous CVD were excluded. Cox regression analyses were performed to estimate the risk of CVD for each low-density lipoprotein cholesterol (LDL-C) group using the < 70 mg/dL as the reference group.ResultsThere were 78,560 cases of stroke (3.91%), and 50,791 myocardial infarction (MI, 2.53%) during a median follow-up of 7.1 years. Among participants not taking statins, LDL-C levels of 130–159 mg/dL and ≥ 160 mg/dL were significantly associated with the risk of MI: the hazard ratios (HRs) (95% confidence interval) were 1.19 (1.14–1.25) and 1.53 (1.46–1.62), respectively. Among participants taking statins, all categories of LDL-C level ≥ 70 mg/dL were significantly associated with increased risk of stroke and MI.ConclusionsWe identified an increased risk of CVD in people with an LDL-C level ≥ 130 mg/dL among individuals with type 2 DM not taking statins. The risk of CVD was significantly higher in those taking statins with an LDL-C level ≥ 70 mg/dL.
Highlights
The aim of the present study was to identify a threshold for the cholesterol level at which the risk of cardiovascular disease (CVD) begins to increase in people with type 2 diabetes mellitus (DM)
We classified the population into statin users and non-users, and we tried to identify a threshold for the cholesterol level at which the risk of CVD begins to increase in people with type 2 DM in each group
Patients were classified as having type 2 DM [7, 10]; (1) when they had at least one service claim with a diagnosis of type 2 DM based on International Classification of Diseases (ICD)-10 (E11–14) in the outpatient or inpatient setting and were prescribed at least one antidiabetic drug at any time over 1 year to exclude prediabetic or non-diabetic individuals or (2) when they showed fasting plasma glucose 126 mg/dL during health examinations
Summary
The aim of the present study was to identify a threshold for the cholesterol level at which the risk of cardiovascular disease (CVD) begins to increase in people with type 2 diabetes mellitus (DM). The cholesterol targets are based on several primary and secondary prevention statin trials that have shown improved outcomes with more intensive LDL-C lowering [1,2,3]. We classified the population into statin users and non-users, and we tried to identify a threshold for the cholesterol level at which the risk of CVD begins to increase in people with type 2 DM in each group
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