Atherogenic index of plasma and its 5-year changes associated with type 2 diabetes risk: a 10-Year cohort study

Abstract

Background: The global burden of type 2 diabetes mellitus (T2DM) is increasing, particularly in resource-limited settings like rural China. Although traditional blood glucose remains an essential measurement for diabetes screening, Atherogenic Index of Plasma (AIP) is emerging as a complementary predictor of T2DM risk. Over time, however, the association between AIP and T2DM risk remains insufficiently understood.

Objective: To investigate the association between baseline AIP levels and its 5-year changes with the risk of T2DM in a rural Chinese cohort.

Methods: This prospective cohort study enrolled 14,968 participants without baseline diabetes from a rural Chinese population. AIP was calculated (log(TG/HDL-C)) and used to classify participant results into quartiles. We conducted multivariate Cox proportional hazards regression analysis, restricted cubic spline analyses, subgroup analyses, and sensitivity analyses to determine the association between baseline AIP and 5-year changes in AIP with the 10-year risk of T2DM.

Results: Over a median follow-up of 10.4 years, 2,165(N = 14,968) participants developed T2DM. The hazard ratios [aHRs; 95% confidence interval (CI)] for T2DM increased with quartiles 2, 3, and 4 (versus quartile 1) of AIP: 1.17 (1.00-1.38), 1.38 (1.18-1.62), and 1.96 (1.68-2.29), respectively (p for trend < 0.0001) after multivariable adjustment. Regarding 5-year changes in AIP, participants with increased AIP levels had a 18% higher risk of developing T2DM (aHRs 1.18, 95% CIs: 1.00-1.40) compared to those maintaining stable levels, while those with decreased AIP showed a 20% reduction in risk (aHRs 0.80, 95% CIs: 0.67-0.95). RCS analyses showed linear relationships for both baseline AIP (p for nonlinearity = 0.927) and 5-year changes in AIP (p for nonlinearity = 0.083) with T2DM risk.

Conclusions: Our findings indicate that both baseline AIP levels and the 5-year changes in those levels are significantly associated with the risk of T2DM. Individuals with higher baseline AIP or 5-year increases in AIP were more likely to develop T2DM.

Keywords: Atherogenic index of plasma; Change in AIP; Cohort study; Hazard ratio; Type 2 diabetes mellitus.

The atherogenic index of plasma (AIP) is a lipid marker associated with cardiovascular risk. This study examined its association with Type 2 Diabetes Mellitus (T2DM) over a 10-year period, focusing on baseline AIP and its 5-year changes. During a median follow-up of 10.4 years, 2,165 participants developed T2DM. Higher levels of AIP were associated with a significantly increased risk of T2DM. Participants with increased AIP had a higher risk of T2DM, while those with decreased AIP had a reduced risk. Our findings suggest that both baseline AIP and its dynamic changes over time are strong predictors of T2DM risk, highlighting its potential role in diabetes prevention and management

Fig. 1

Restricted Cubic Spline Analysis of Baseline AIP (A) and 5-year Changes in AIP with 10-year Risk of T2DM. A linear association between AIP and the risk of T2DM was found (P > 0.05). The shaded area represents the 95% confidence interval, indicating the precision of the estimated association across different levels of AIP and its 5-year changes. The histogram in the background shows the distribution of AIP and its 5-year changes values among the study population

Fig. 2

Subgroup Analysis of the Association Between Baseline AIP (A) and 5-year Changes in AIP (B) with