Abstract
BackgroundRecent guidelines highlighted the association between atherosclerosis and triglyceride-enriched lipoproteins in patients with impaired glucose metabolism. However, evidence from prospective studies for long-term prognostic utility of low-density lipoprotein triglyceride (LDL-TG) in real-world patients with prediabetes (Pre-DM) or diabetes mellitus (DM) and coronary artery disease (CAD) is currently not available. The aim of the present study was to evaluate the impact of LDL-TG on major adverse cardiovascular events (MACEs) in patients with stable CAD under different glucose metabolism status.MethodsA total of 4381 patients with CAD were consecutively enrolled and plasma LDL-TG level was measured by an automated homogeneous assay. They were categorized according to both status of glucose metabolism [DM, Pre-DM, normal glycaemia regulation (NGR)] and tertiles of LDL-TG. All subjects were followed up for the occurrence of MACEs.ResultsDuring a median of 5.1 (interquartile range 3.9 to 5.9) years’ follow-up, 507 (11.6%) MACEs occurred. Cubic spline models showed a significant association between LDL-TG and MACEs in DM and Pre-DM but not in NGR. When the combined effect of elevated LDL-TG and glucose disorders was considered for risk stratification, the medium tertile of LDL-TG plus DM, and the highest tertile of LDL-TG plus Pre-DM or plus DM subgroups were associated with significantly higher risk of MACEs after adjustment of confounders including triglyceride [hazard ratios (95% confidence intervals): 1.843 (1.149–2.955), 1.828 (1.165–2.867), 2.212 (1.396–3.507), all p < 0.05]. Moreover, adding LDL-TG into the original model increased the C-statistic from 0.687 to 0.704 (∆C-statistic = 0.016, p = 0.028) and from 0.734 to 0.749 (∆C-statistic = 0.014, p = 0.002) in Pre-DM and DM, respectively.ConclusionsIn this longitudinal cohort study on real-world practice, higher LDL-TG was associated with worse outcomes among Pre-DM and DM patients with stable CAD.
Highlights
Recent guidelines highlighted the association between atherosclerosis and triglyceride-enriched lipoproteins in patients with impaired glucose metabolism
We aim to investigate the different relations of low-density lipoprotein triglyceride (LDL-TG) levels to major cardiovascular events (MACEs) in stable coronary artery disease (CAD) patients with different glucose metabolism status under real-world clinical practice
Baseline characteristics Patients were divided into three groups according to different glucose metabolism status (NGR: n = 926, Pre-diabetes mellitus (DM): n = 1789, DM n = 1666, Table 1)
Summary
Recent guidelines highlighted the association between atherosclerosis and triglyceride-enriched lipoproteins in patients with impaired glucose metabolism. In the Atherosclerosis Risk in Communities (ARIC) study, the prognostic value of LDL-TG trumped that of remnant cholesterol (RC) in patients without CAD at baseline [7] As it was reported by McKeone et al, LDL with elevated TG contents formed in vitro had reduced proteolytic cleavage of apo B-100 [10]. Plasma levels of LDL-TG were elevated when more TGs were transferred from very low density lipoprotein (VLDL) to LDL via cholesteryl ester transfer protein (CETP) [11]. This hypertriglyceridemiamediated pathway was more active when individuals presented glycemic metabolism disorders [11, 12]
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