Many patients with type 2 diabetes mellitus (T2DM) have relatively normal levels of
low-density lipoprotein (LDL) cholesterol yet have increased risk for cardiovascular
events. Distribution of lipoprotein subclasses in patients with T2DM who have achieved
very low levels of LDL cholesterol (<50 mg/dl) or non–high-density lipoprotein (HDL)
cholesterol (<80 mg/dl) have not been extensively examined. The aim of this study
was to assess variations in lipoprotein particle concentration in patients with diabetes
with “very low” LDL cholesterol and non-HDL cholesterol levels to elucidate the drivers
of residual cardiovascular risk. Data were selected from a single large clinical laboratory
database. Cases were patients with T2DM diagnosis codes (International Classification
of Diseases, Ninth Revision, codes 250 to 250.93). Lipoprotein particle concentrations
were analyzed using nuclear magnetic resonance spectroscopy. The Friedewald equation
was used to calculate LDL cholesterol. Among the 1,970 patients with T2DM, the mean
age was 61 years, and approximately 51% were men. At LDL cholesterol concentrations
<50 mg/dl (triglyceride <150 mg/dl and HDL cholesterol >40 mg/dl), 16% had LDL particle
concentrations <500 nmol/L, 70% had concentrations of 500 to 1,000 nmol/L, and 14%
had concentrations >1,001 nmol/L. At non-HDL cholesterol levels <80 mg/dl, 8% had
LDL particle concentrations <500 nmol/L, 67% had concentrations of 500 to 1,000 nmol/L,
and 25% had concentrations >1,001 nmol/L. In conclusion, despite attainment of LDL
cholesterol <50 mg/dl or non-HDL cholesterol <80 mg/dl, patients with diabetes exhibited
significant variation in LDL particle levels, with most having LDL particle concentrations
>500 nmol/L, suggesting the persistence of potential residual coronary heart disease
risk.
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Article info
Publication history
Published online: May 24, 2012
Accepted:
April 26,
2012
Received in revised form:
April 26,
2012
Received:
January 18,
2012
Footnotes
Dr. Malave serves on the speaker's bureaus for Abbott Laboratories, Abbott Park, Illinois, and LipoScience, Inc., Raleigh, North Carolina. Dr. Castro is a Clinical Intern at St. Joseph's Hospital, Atlanta, Georgia. Dr. Burkle serves on the speaker's bureaus for Abbott Laboratories and LipoScience, Inc. Dr. Voros serves on the speaker's bureaus for Abbott Laboratories and Health Diagnostic Laboratory, Inc., Richmond, Virginia. Dr. Dayspring serves on the speaker's bureaus for Abbott Laboratories; Kowa, Nagoya, Japan; Merck & Company, Whitehouse Station, New Jersey; Health Diagnostic Laboratory, Inc.; and LipoScience, Inc. Dr. Honigberg serves as chief medical officer at LipoScience, Inc. Dr. Pourfarzib is vice president of medical affairs at LipoScience, Inc.
Identification
Copyright
© 2012 Published by Elsevier Inc.
