Abstract
BackgroundSmall, dense low-density lipoprotein (sd-LDL) increases in type 2 diabetes patients and causes arteriosclerosis. Non–high-density-lipoprotein cholesterol (non–HDL-C) is thought to be useful for predicting arteriosclerosis and sd-LDL elevation; however, there are no data about whether the triglyceride /low-density-lipoprotein cholesterol (TG/LDL-C) ratio is a valuable predictor for sd-LDL.MethodsA total of 110 type 2 diabetes patients with hypertriglyceridemia were analyzed. No patients were treated with fibrates, but 47 patients were treated with statins. LDL-C was measured by the direct method. LDL-migration index (LDL-MI) using electrophoresis (polyacrylamide gel, PAG) was calculated, and a value ≥0.400 was determined to indicate an increase in sd-LDL. Simple regression analyses were carried out between LDL-MI and lipid markers. Receiver operating characteristic curves of lipid markers for predicting high LDL-MI were applied to determine the area under the curve (AUC), sensitivity, specificity, and cut-off point.ResultsLDL-MI correlated negatively with LDL-C (P = 0.0027) and PAG LDL fraction (P < 0.0001) and correlated positively with TGs, non–HDL-C, TG/LDL-C ratio, TG/HDL-C ratio, and non–HDL-C/HDL-C ratio among all study patients. Similar results were obtained for patients analyzed according to statin treatment. The AUCs (95% confidence interval) were 0.945 (0.884-1.000) for TG/LDL-C ratio and 0.614 (0.463-0.765) for non–HDL-C in patients without statins (P = 0.0002). The AUCs were 0.697 (0.507-0.887) for TG/LDL-C and 0.682 (0.500-0.863) for non–HDL-C in patients treated with statins. The optimal cut-off point for TG/LDL-C ratio for increased LDL-MI was 1.1 (molar ratio) regardless of statin treatment. The sensitivity and specificity of the TG/LDL-C ratio (90.0 and 93.9%, respectively) were higher than those of non–HDL-C (56.7 and 78.8%, respectively) in patients without statins.ConclusionsThe TG/LDL-C ratio is a reliable surrogate lipid marker of sd-LDL and superior to non–HDL-C in type 2 diabetes patients not treated with statins.
Highlights
The risk of cardiovascular disease (CVD) is reportedly associated with an increase in small, dense low-density lipoprotein levels rather than large, buoyant LDL [1]
Comparing patients with and without statin treatment, the mean age was higher in patients treated with statins (66.6 [9.8] years) than in those not treated with statins (59.4 [13.6] years) (P = 0.0027, t-test), and the average estimated glomerular filtration rate (eGFR) was lower in patients treated with statins (66.6 [13.4] mL/min/1.73 m2) than in those not treated with statins (76.7 [21.1] mL/min/ 1.73 m2) (P = 0.0051)
With regard to lipid markers, patients treated with statins were characterized by lower TGs, higher HDL-C, and lower non–HDL-C levels compared with patients not treated with statins
Summary
The risk of cardiovascular disease (CVD) is reportedly associated with an increase in small, dense low-density lipoprotein (sd-LDL) levels rather than large, buoyant LDL [1]. Japanese elderly men with ischemic heart disease and high sd-LDL were shown to have increased risk of CVD events over the 5 years [3]. Higher sd-LDL occurs when both non–high-density-lipoprotein cholesterol (non–HDL-C) and triglycerides (TGs) are high [4]. According to current guidelines for arteriosclerosis, non–HDL-C should be evaluated instead of LDL-C in cases such as severe hypertriglyceridemia [7]. Dense low-density lipoprotein (sd-LDL) increases in type 2 diabetes patients and causes arteriosclerosis. Non–high-density-lipoprotein cholesterol (non–HDL-C) is thought to be useful for predicting arteriosclerosis and sd-LDL elevation; there are no data about whether the triglyceride /low-densitylipoprotein cholesterol (TG/LDL-C) ratio is a valuable predictor for sd-LDL
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