Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 6;19(1):127.
doi: 10.1186/s12944-020-01292-w.

Apolipoprotein B and non-high-density lipoprotein cholesterol reveal a high atherogenicity in individuals with type 2 diabetes and controlled low-density lipoprotein-cholesterol

Liliana Fonseca  1 , Sílvia Paredes  2 , Helena Ramos  3 , José Carlos Oliveira  4 , Isabel Palma  3
Affiliations

Apolipoprotein B and non-high-density lipoprotein cholesterol reveal a high atherogenicity in individuals with type 2 diabetes and controlled low-density lipoprotein-cholesterol

Liliana Fonseca et al. Lipids Health Dis. .

Abstract

Background: Lipid-lowering therapy is guided by Low-density-lipoprotein cholesterol (LDL-c) levels, although the cardiovascular disease (CVD) risk could be better reflected by other lipid parameters. This study aimed at comparing a comprehensive lipid profile between patients with type 2 diabetes mellitus (T2DM) with LDL-c concentration within and above target.

Methods: A comprehensive lipid profile was characterized in 96 T2DM patients. The European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2016 and 2019 Guidelines for the Management of Dyslipidemias were used to define LDL-c targets.

Results: In this population, only 28.1 and 16.7% of patients had mean LDL-c levels within target, as defined by the 2016 and 2019 guidelines, respectively. Applying the 2016 guidelines criteria, in patients with LDL-c within target, 22, 25 and 44% presented non-high-density lipoprotein cholesterol (non-HDL-c), Apolipoprotein B (ApoB) and oxidized LDL-c levels above the recommended range, respectively, whereas according to the 2019 guidelines criteria, 50, 39 and 44% of the patients with LDL-c within target had elevated high-density lipoprotein cholesterol (HDL-c), ApoB and oxidized LDL-c levels, respectively. LDL-c was strongly correlated with non-HDL-c (r = 0.850), ApoB (r = 0.656) and oxidized LDL-c (r = 0.508). Similarly, there was a strong correlation between non-HDL-c with both ApoB (r = 0.808) and oxidized LDL-c (r = 0.588).

Conclusions: These findings emphasize the limitations of only considering LDL-c concentration for cardiovascular (CV) risk assessment. Targeting only LDL-c could result in missed opportunities for CV risk reduction in T2DM patients. These data suggest that non-HDL-c, ApoB and oxidized LDL-c levels could be considered as an important part of these patients' evaluation allowing for a more accurate estimation of CV risk and hopefully better management of these high-risk patients.

Keywords: ApoB; CV risk; CVD; Dyslipidemia; LDL-c; Non-HDL cholesterol; T2DM.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Liliana Fonseca declares that she has no conflict of interest. Silvia Paredes declares that she has no conflict of interest. Helena Ramos declares that she has no conflict of interest. José Carlos Oliveira declares that he has no conflict of interest. Isabel Palma declares that she has no conflict of interest.

Comment in

  • Discordant serum lipid parameters.
    Kurmus O, Aslan T, Eren M, Akbuga K, Fonseca L, Paredes S, Palma I. Kurmus O, et al. Lipids Health Dis. 2021 Feb 11;20(1):10. doi: 10.1186/s12944-021-01445-5. Lipids Health Dis. 2021. PMID: 33573640 Free PMC article. No abstract available.

References

    1. Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovasc Diabetol. 2018;17:83. - PMC - PubMed
    1. Association AD 10. Cardiovascular disease and risk management: standards of medical Care in Diabetes—2020. Diabetes Care. 2020;43:S111–S134. - PubMed
    1. Strain WD, Paldanius P. Diabetes, cardiovascular disease and the microcirculation. Cardiovasc Diabetol. 2018;17:57. - PMC - PubMed
    1. Raghavan S, Vassy JL, Ho YL, Song RJ, Gagnon DR, Cho K, Wilson PW, Phillips LS. Diabetes mellitus–related all-cause and cardiovascular mortality in a National Cohort of adults. J Am Heart Assoc. 2019;8:e011295. - PMC - PubMed
    1. Mach F, Baigent C, Catapano AL, Koskina KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–118. - PubMed