Diabetes Metab J.  2023 Jan;47(1):45-58. 10.4093/dmj.2021.0344.

Cardiovascular Outcomes according to Comorbidities and Low-Density Lipoprotein Cholesterol in Korean People with Type 2 Diabetes Mellitus

• Moon MK
• Noh J
• Rhee EJ
• Park SH
• Kim HC
• Kim BJ
• Kim HJ
• Choi S
• Na JO
• Hyun YY
• Kim BJ
• Han KD
• Jeong IK
• on Behalf of the Committee of Practice Guideline of Korean Lipid and Atheroscelerosis

• KMID: 2538930
• DOI: http://doi.org/10.4093/dmj.2021.0344

Abstract

Background
There are no clear data to support the cardiovascular (CV) risk categories and low-density lipoprotein cholesterol (LDL-C) treatment goals in Korean people with type 2 diabetes mellitus (T2DM). We evaluated the incidence of cardiovascular disease (CVD) according to comorbidities and suggested LDL-C treatment goals in Korean people with T2DM in nationwide cohort data.
Methods
Using the Korean National Health Insurance Service database, 248,002 people aged 30 to 90 years with T2DM who underwent routine health check-ups during 2009 were included. Subjects with previous CVD were excluded from the study. The primary outcome was incident CVD, defined as a composite of myocardial infarction and ischemic stroke during the follow-up period from 2009 to 2018.
Results
The mean age of the study participants was 59.6±10.9 years, and median follow-up period was 9.3 years. CVD incidence increased in the order of DM duration of 5 years or more (12.04/1,000 person-years), hypertension (HT) (12.27/1,000 personyears), three or more CV risk factors (14.10/1,000 person-years), and chronic kidney disease (18.28/1,000 person-years). The risk of incident CVD increased linearly from an LDL-C level of ≥70 mg/dL in most patients with T2DM. In T2DM patients without HT or with a DM duration of less than 5 years, the CVD incidence increased from LDL-C level of ≥100 mg/dL.
Conclusion
For primary prevention of CVD in Korean adults with T2DM, it can be helpful to lower LDL-C targets when there are chronic kidney disease, HT, a long duration of diabetes mellitus, or three or more CV risk factors.

Keyword

Cardiovascular diseases; Cholesterol; Diabetes mellitus; Dyslipidemias; Korea

Figure

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  Fig. 1. Incidence of cardiovascular disease (CVD) according to low-density lipoprotein cholesterol (LDL-C) levels in total subjects with diabetes mellitus (A) and in those with comorbidities (B). Multivariable Cox proportional hazards regression analysis was performed by adjusting for age, sex, body mass index, hypertension (HT), current smoking, alcohol intake, regular physical activity, estimated glomerular filtration rate, triglyceride-lowering medication, and statin treatment. Risk factors: age (male ≥45 years, female ≥55 years), family history of CVD, HT (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or taking antihypertensive drugs), current smoking, low high-density lipoprotein cholesterol (<40 mg/dL). HR, hazard ratio; CI, confidence interval. aP<0.001 compared with an LDL-C level of <70 mg/dL.

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