Discordance between lipid markers used for predicting cardiovascular risk in patients with type 2 diabetes

Abstract

Aims Non-high density lipoprotein cholesterol (non-HDL-C) is gaining importance over low density lipoprotein cholesterol (LDL-C) as cardiovascular risk marker in patients with type 2 diabetes. It represents the overall lipid burden and is a surrogate marker for the apolipoprotein B. We studied the discordance between the old (LDL-C) and the new (non-HDL-C) lipid markers in a large group of diabetes patients.

Methods The lipid profile data of all diabetes (T2DM, aged 18–75, using oral or injectable anti diabetic agents) patients was analyzed in this study. We excluded patients with type1 diabetes, secondary forms of diabetes and gestational diabetes. Elevated lipid parameters (LDL > 100 mg/dL and non HDL-C > 130 mg/dL) were defined as per the guidelines of Adult Treatment Panel III.

Results The study participants (409 M:360 F) had a mean age of 47.3 ± 12.4 years, BMI of 28.4 ± 5.6 kg/m2 and an A1c of 8.8 ± 2.2%. Elevated LDL-C was observed in 383 patients (49.8%) and elevated non HDL-C in 418 (54.4%) patients. Of the 383 patients with elevated LDL-C, 346 (90.3%) had corresponding elevated levels of non-HDL-C and out of 418 patients with elevated non HDL-C, 346 (83%) had elevated LDL-C. Discordance between the elevated LDL-C and non-HDL-C values were greater among patients with low triglyceride levels when compared with those with high triglycerides (Pearson's χ2 test = 67.7; P < 0.001).

Conclusion Our data suggest a significant discordance between the LDL-C and non-HDL-C in patients with diabetes. This discordance leads to the residual cardiovascular risk in diabetes patients.