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ADA: LDL Doesn’t Predict Heart Risk in Diabetes

Jun 20, 2014

LDL cholesterol wasn’t a good predictor of cardiovascular disease in type 1 diabetes, but the total cholesterol-to-HDL ratio appeared more reliable, an observational study showed…. 

Christel Hero, MD, of Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues reported that, LDL had modest associations with development of cardiovascular disease but no consistent dose-response above the 100 mg/dL threshold for statin treatment in this population.

In type 1 diabetes patients already on statins, LDL levels didn’t have any significant link to subsequent cardiovascular disease in the Swedish National Diabetes Register data.

The cholesterol-to-HDL ratio had likewise modest links to cardiovascular disease in patients on or off lipid medications, but with a consistent rise in risk across categories.

Hero added, "The ratio of cholesterol-to-HDL is a more reliable marker for risk when considering primary prevention."

Fernando Ovalle, MD, director of the Comprehensive Diabetes Center of the University of Alabama at Birmingham, commented, "The findings emphasized how much remains unknown about cardiovascular disease in type 1 diabetes."

"We made a lot of assumptions and jumped to a lot of conclusions that the markers of cardiovascular disease and treatments for prevention of cardiovascular diseases will be the same in type 1 — and that just may not be the case." "This could potentially change the perspective on how we see the use of statins and the assessment of cardiovascular risk in general."

Elizabeth Seaquist, MD, ADA president for medicine and science and a moderator at the session cautioned, "Don’t toss out LDL in clinical practice just yet." Dr. Seaquist continued saying that LDL may not be as strong a predictor for cardiovascular disease as in type 2, as has been suspected from prior studies, but further research is needed to determine what to use in the clinic. "These patients are still at great risk for cardiovascular events, and we need to make certain that we’re doing the right things to prevent that," she said. "It will help us if we were to do a trial to determine the benefits of lipid-lowering in type 1 patients, how we might design it. They don’t have particularly high LDLs in general."

Practice Pearls:
  • LDL cholesterol wasn’t a good predictor of cardiovascular disease in type 1 diabetes, but the total cholesterol-to-HDL ratio appeared more reliable.
  • Note that some of the higher cholesterol-to-HDL ratio octiles showed significantly higher cardiovascular risk than the lowest ratio category of 2.22 and below in all three patient subgroups.
  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

American Diabetes Association: Source reference: Hero C, et al "LDL-cholesterol is not a good marker of cardiovascular risk in type 1 diabetes: Observational study in 30,778 patients — a report from the National Diabetes Register in Sweden" ADA 2014; Abstract 381-OR.