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Observational Study
. 2021 Jan 17;11(1):e037340.
doi: 10.1136/bmjopen-2020-037340.

Atherogenic dyslipidaemia and cardiovascular events in patients with diabetes or pre-diabetes and stable coronary artery disease: a prospective, cohort study

Jing-Lu Jin  1   2 , Ye-Xuan Cao  1 , Li-Guo Wu  3 , Xiang-Dong You  3 , Na Guo  3 , Yuan-Lin Guo  1 , Na-Qiong Wu  1 , Cheng-Gang Zhu  1 , Rui-Xia Xu  1 , Hui-Hui Liu  1 , Jing Sun  1 , Qian Dong  1 , Ying Gao  4 , Jian-Jun Li  4
Affiliations
Observational Study

Atherogenic dyslipidaemia and cardiovascular events in patients with diabetes or pre-diabetes and stable coronary artery disease: a prospective, cohort study

Jing-Lu Jin et al. BMJ Open. .

Abstract

Objective: The aim of the study was to investigate the impacts of triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) dyslipidaemia on prognosis in coronary artery disease (CAD) patients with different glucose metabolism status.

Design: An observational cohort study.

Setting/participants: A total of 3057 patients with stable CAD were consecutively enrolled and divided into three groups according to different glucose metabolism status. Atherogenic dyslipidaemia (AD) was defined as TG ≥1.7 mmol/L and HDL-C <1.0 mmol/L for men or <1.3 mmol/L for women. The patients were further classified into six subgroups by status of AD. All subjects were followed up for the cardiovascular events (CVEs).

Primary outcome measures: The primary endpoints were cardiovascular mortality, non-fatal myocardial infarction and non-fatal stroke.

Results: During a median follow-up of 6.1 years, 308 (10.1%) CVEs occurred. No significant difference in the occurrence of CVEs was observed between normal glucose regulation (NGR) and pre-diabetes (pre-DM) groups (HR: 1.25, 95% CI 0.89 to 1.76) while DM group presented 1.45-fold higher risk of CVEs (HR: 1.45, 95% CI 1.02 to 2.05). When the participants were categorised according to combined status of two parameters, the cardiovascular risk was significantly elevated in pre-DM or DM plus AD group compared with the NGR plus non-AD group (HR: 1.76, 95% CI 1.10 to 2.80 and HR: 1.87, 95% CI 1.17 to 2.98).

Conclusions: The present study suggested that the presence of AD might affect the prognosis in patients with DM or pre-DM and stable CAD.

Keywords: coronary heart disease; general diabetes; lipid disorders.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart of the study. ACS, acute coronary syndrome; CABG, coronary artery bypass grafting; CAD, coronary artery disease; DM, diabetes mellitus; NGR, normal glucose regulation; PCI, percutaneous coronary intervention; pre-DM, pre-diabetes mellitus.
Figure 2
Figure 2
Coronary severity in participants according to (A) different glucose metabolism; (B) different status of glucose metabolism and atherogenic dyslipidaemia. *p<0.05; **p<0.01. AD, atherogenic dyslipidaemia; DM, diabetes mellitus; NGR: normal glucose regulation.
Figure 3
Figure 3
Kaplan-Meier curves and log-rank tests for cardiovascular events in participants according to (A) different glucose metabolism; (B) different status of glucose metabolism and atherogenic dyslipidaemia. AD, atherogenic dyslipidaemia; DM, diabetes mellitus; NGR, normal glucose regulation.
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