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Coronary Artery Disease Risk Prediction by Combined Stratification of Low-Density and High-Density Lipoprotein Cholesterol Levels Across Different Glucose Statuses
TAKE-HOME MESSAGE
- In this study, the authors assessed the relationship between low-density lipoprotein cholesterol (LDL-C) levels and the occurrence of coronary artery disease (CAD), taking into account high-density lipoprotein cholesterol (HDL-C) levels and glucose status. They found that elevated LDL-C levels consistently increased the risk of new-onset CAD across all glucose levels. Additionally, lower HDL-C levels and higher LDL-C levels were associated with an increased risk of CAD. The study also showed that individuals with diabetes were at a higher risk of CAD than those with normal or borderline high blood sugar levels. Even in individuals with borderline high blood sugar levels, HDL-C levels below 40 mg/dL were associated with a notable risk of CAD.
- Based on current data, it is important to consider adjusting LDL-C target levels according to glucose status and HDL-C levels to tailor treatment on an individual basis.
abstract
This abstract is available on the publisher's site.
Access this abstract nowAIM
To investigate the association between low-density lipoprotein-cholesterol (LDL-C) levels and coronary artery disease (CAD) incidence based on combining high-density lipoprotein-cholesterol (HDL-C) levels and glucose status.
MATERIALS AND METHODS
In this retrospective cohort study, we used data from a nationwide claims database (1,524,289 individuals without a history of CAD or familial hypercholesterolaemia; 2008-2019). Cox proportional hazards modelling identified the risk of incident CAD by a novel combination of four HDL-C levels, seven LDL-C levels and glucose status.
RESULTS
During the follow-up period (mean: 5.5 years), 8301 (0.99/1000 person-years) events occurred. The risk of CAD increased from lower LDL-C levels accompanied by lower HDL-C levels regardless of the glucose status. Using the most favourable levels of HDL-C and LDL-C (i.e. 60-99 mg/dL and <80 mg/dL, respectively) as references, the hazard ratios (95% confidence interval) for the group with HDL-C levels <40 mg/dL and LDL-C levels <80 mg/dL were 2.74 (1.47-5.11), 2.52 (1.30-4.91) and 2.85 (1.68-4.84) for normoglycaemia, borderline glycaemia and diabetes, respectively. Comparison of the most favourable levels of HDL-C and LDL-C with their least favourable levels (i.e. <40 mg/dL and 180-199 mg/dL, respectively) revealed that the risk of new-onset CAD exhibited a 19-, nine- and seven-fold increase in individuals with normoglycaemia, borderline glycaemia and diabetes, respectively.
CONCLUSIONS
To prevent CAD, LDL-C levels should be strictly controlled in patients with low HDL-C levels regardless of glucose tolerance. Individualized treatment, which involves setting target LDL-C levels based on glucose tolerance and HDL-C values, is required.
Additional Info
Disclosure statements are available on the authors' profiles:
Coronary artery disease risk prediction by combined stratification of low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol levels across different glucose statuses
Diabetes Obes Metab 2024 Sep 24;[EPub Ahead of Print], J Yachida, K Fujihara, M Harada Yamada, A Kobayashi, LM Khin, H Takizawa, M Yamamoto, M Kitazawa, Y Matsubayashi, T Yamada, S Kodama, H SoneFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.