Differing Associations of Lipid and Lipoprotein Disturbances With the Macrovascular and Microvascular Complications of Type 1 Diabetes
- Nish Chaturvedi, MRCP1,
- John H. Fuller, FRCP1,
- Marja-Riitta Taskinen, MD2 and
- On behalf of the EURODIAB PCS Group
- 1EURODIAB, Department of Epidemiology and Public Health, University College London, London, U.K.
- 2Department of Medicine, University of Helsinki, Helsinki, Finland
Abstract
OBJECTIVE—Cardiovascular disease (CVD) is increased in patients with type 1 diabetes, but lipid and lipoprotein patterns remain favorable. In contrast, nephropathy is associated with an adverse distribution. We compared the associations and predictive power of lipid and lipoprotein disturbances with these complications.
RESEARCH DESIGN AND METHODS—A nested case-control study from the EURODIAB cohort of 140 case subjects with evidence of at least one complication and 84 control subjects with no complications were analyzed. Conventional and unconventional lipid and lipoprotein fractions, including apolipoprotein (apo)-A1, lipoprotein (Lp)-A1, LpA1/A2, apoB, and LDL particle size were measured centrally.
RESULTS—CVD was only associated with increased LDL cholesterol (3.6 vs. 3.0 mmol/l, P = 0.02). In contrast, albuminuria was associated with elevated cholesterol, triglyceride, LDL, and apoB and with diminished LDL particle size. No disturbances in HDL and related lipoproteins were noted. In normoalbuminuric patients, CVD was not associated with any significant changes in lipids. CVD in macroalbuminuric patients was associated with increased triglyceride level (2.37 vs. 1.07 mmol/l, P = 0.001; P = 0.02 for CVD/albuminuria interaction) and LDL cholesterol (5.4 vs. 3.3 mmol/l, P = 0.005; P = 0.004 for interaction). Independent associations were observed for total cholesterol and for LDL particle size and albuminuria.
CONCLUSIONS—Abnormalities in lipid and lipoprotein disturbances are more closely related to albuminuria than to CVD in patients with type 1 diabetes. Measurement of conventional parameters provide sufficient risk information. ApoB and LDL particle size offer limited extra information. HDL metabolism remains undisturbed in the presence of complications. These changes reflect associations with glycemic control, which is the key to understanding lipid and lipoprotein disturbances.
- AER, albumin excretion rate
- apo, apolipoprotein
- CVD, cardiovascular disease
- Lp, lipoprotein
- SRE, standardized regression effect
Footnotes
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Address correspondence and reprint requests to Nish Chaturvedi, Professor of Clinical Epidemiology, Department of Epidemiology and Public Health, Imperial College of Medicine at St. Mary’s, Norfolk Place, London W2 1PG, U.K. E-mail: n.chaturvedi{at}ic.ac.uk.
Received for publication 1 May 2001 and accepted in revised form 13 August 2001.
Marja-Riitta Taskinen has received honoraria for speaking engagements from Merck, Pfizer Pharmaceuticals Group, and Glaxo Smith Kline and has been a paid consultant of Laboratories NEGMA (France). The laboratory FORNIER S.A. provides funds to Dr. Taskinen’s laboratory to conduct studies to examine prevention of coronary heart disease in patients with type 2 diabetes. Novartis Pharma AG provides funds to Dr. Taskinen’s laboratory to conduct studies on a new drug to lower blood glucose.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
