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- Title
Long-term prognostic utility of low-density lipoprotein (LDL) triglyceride in real-world patients with coronary artery disease and diabetes or prediabetes.
- Authors
Jin, Jing-Lu; Zhang, Hui-Wen; Cao, Ye-Xuan; Liu, Hui-Hui; Hua, Qi; Li, Yan-Fang; Zhang, Yan; Guo, Yuan-Lin; Wu, Na-Qiong; Zhu, Cheng-Gang; Xu, Rui-Xia; Gao, Ying; Li, Xiao-Lin; Cui, Chuan-Jue; Liu, Geng; Sun, Jing; Dong, Qian; Santos, Raul; Li, Jian-Jun
- Abstract
Background: Recent 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. Methods: A 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. Results: During 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. Conclusions: In 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.
- Subjects
CORONARY disease; LOW density lipoproteins; GLUCOSE metabolism; TRIGLYCERIDES; CARDIOVASCULAR diseases
- Publication
Cardiovascular Diabetology, 2020, Vol 19, Issue 1, p1
- ISSN
1475-2840
- Publication type
Article
- DOI
10.1186/s12933-020-01125-1