Abstract
BackgroundDyslipidemia is a major cardiovascular risk factor and common in diabetes patients. Most guidelines focus on optimal lipid levels, while variation of lipid profiles is far less discussed. This study aims to investigate the association of visit-to-visit variability in blood lipids with all-cause, cardiovascular, and non-cardiovascular mortality in patients with type 2 diabetes.MethodsWe identified 10,583 type 2 diabetes patients aged ≥ 30 years with follow-up ≥ 3 years and who participated in the Diabetes Care Management Program at a medical center in Taiwan. Variability in lipid profiles within 3 years after entry was calculated using coefficient of variation. Cox proportional hazard models were used to evaluate lipid variability in relation to subsequent mortality.ResultsOver a mean follow-up of 6.4 years, 1838 all-cause deaths (809 cardiovascular deaths) were observed. For each 10% increase in variability in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol, the hazard ratios (95% confidence intervals) of all-cause mortality were 1.30 (1.22–1.37), 1.05 (1.01–1.09), and 1.10 (1.03–1.16), respectively; those of cardiovascular mortality were 1.27 (1.16–1.39), 1.08 (1.02–1.15), and 1.16 (1.07–1.27), respectively. Each 10% increase in high-density lipoprotein cholesterol variability conveyed 31% greater risk of non-cardiovascular mortality. High variability in total cholesterol and low-density lipoprotein cholesterol increased all-cause mortality in subgroups of nonsmoking, regular exercising, non-dyslipidemia, and more severe status of diabetes at baseline.ConclusionsBlood lipid variability except for triglyceride variability was associated with all-cause and cardiovascular mortality in patients with type 2 diabetes.
Highlights
Dyslipidemia is a major cardiovascular risk factor and common in diabetes patients
Diabetes increases the risk of cardiovascular disease (CVD) by two folds on average, and earlier onset of diabetes is associated with higher mortality rate, which is mostly attributed to CVD mortality [4, 5]
A total of 10,583 diabetes patients were followed up for a mean of 6.4 years. 1,838 all-cause deaths, 809 CVD deaths, and 1,029 non-CVD deaths were observed, which resulted in crude incident density rates of 27.32, 12.03, and 15.30 per 1000 person-years, respectively
Summary
Dyslipidemia is a major cardiovascular risk factor and common in diabetes patients. This study aims to investigate the association of visit-to-visit variability in blood lipids with all-cause, cardiovascular, and non-cardiovascular mortality in patients with type 2 diabetes. Diabetes increases the risk of cardiovascular disease (CVD) by two folds on average, and earlier onset of diabetes is associated with higher mortality rate, which is mostly attributed to CVD mortality [4, 5]. Diabetes mellitus (DM) and dyslipidemia are recognized as classic risk factors for CVD [7, 8]. Blood lipids play an essential role in atherosclerosis and the progression of CVD, and they may mediate the association between diabetes and CVD [9]. Abnormal lipid profiles have increased CVD and all-cause mortality [10, 11]
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