Diabetes Metab J.  2023 Nov;47(6):837-845. 10.4093/dmj.2022.0217.

Comparison of on-Statin Lipid and Lipoprotein Levels for the Prediction of First Cardiovascular Event in Type 2 Diabetes Mellitus

  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea


A substantial cardiovascular disease risk remains even after optimal statin therapy. Comparative predictiveness of major lipid and lipoprotein parameters for cardiovascular events in patients with type 2 diabetes mellitus (T2DM) who are treated with statins is not well documented.
From the Korean Nationwide Cohort, 11,900 patients with T2DM (≥40 years of age) without a history of cardiovascular disease and receiving moderate- or high-intensity statins were included. The primary outcome was the first occurrence of major adverse cardiovascular events (MACE) including ischemic heart disease, ischemic stroke, and cardiovascular death. The risk of MACE was estimated according to on-statin levels of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), highdensity lipoprotein cholesterol (HDL-C), and non-HDL-C.
MACE occurred in 712 patients during a median follow-up period of 37.9 months (interquartile range, 21.7 to 54.9). Among patients achieving LDL-C levels less than 100 mg/dL, the hazard ratios for MACE per 1-standard deviation change in ontreatment values were 1.25 (95% confidence interval [CI], 1.07 to 1.47) for LDL-C, 1.31 (95% CI, 1.09 to 1.57) for non-HDL-C, 1.05 (95% CI, 0.91 to 1.21) for TG, and 1.16 (95% CI, 0.98 to 1.37) for HDL-C, after adjusting for potential confounders and lipid parameters mutually. The predictive ability of on-statin LDL-C and non-HDL-C for MACE was prominent in patients at high cardiovascular risk or those with LDL-C ≥70 mg/dL.
On-statin LDL-C and non-HDL-C levels are better predictors of the first cardiovascular event than TG or HDL-C in patients with T2DM.


Cholesterol, LDL; Diabetes mellitus, type 2; Heart disease risk factors; Hydroxymethylglutaryl-CoA reductase inhibitors; Lipids


  • Fig. 1. Hazard ratios (HRs) of major adverse cardiovascular events (MACE) according to on-treatment concentrations of (A) low-density lipoprotein cholesterol (LDL-C), (B) triglyceride (TG), (C) high-density lipoprotein cholesterol (HDL-C), and (D) non-HDL-C in patients with LDL-C levels <100 mg/dL receiving moderate- or high-intensity staitn therapy. The bars above x-axis, called ‘rug line,’ show the density of the independent variable. The thicker and more common bars mean there are more observations in that area.

  • Fig. 2. Risk of major cardiovascular events per 1-standard deviation (SD) changes in on-treatment lipid parameters in patients with low-density lipoprotein cholesterol (LDL-C) levels (A) ≥70 and <100 mg/dL, (B) ≥55 and <70 mg/dL, and (C) <55 mg/dL receiving moderate- or high-intensity statin therapy. Data are presented as adjusted hazard ratios (HRs) and 95% confidence intervals. P values for interactions between LDL-C levels ≥70 and <100 mg/dL and LDL-C below 70 mg/dL are 0.104 (model B) and 0.101 (model C) for LDL-C; 0.296 (model B) and 0.420 (model C) for triglyceride (TG); 0.231 (model B) and 0.200 (model C) for high-density lipoprotein cholesterol (HDL-C); and 0.167 (model B) and 0.166 (model C) for non-HDL-C. aHR per 1-SD decrease of HDL-C, bAdjusted for age, sex, duration of diabetes, waist circumference, mean fasting blood glucose, mean systolic blood pressure, smoking, alcohol consumption, physical activity, duration of statin therapy, and concurrent medications (antihypertensive agents by class, antidiabetic agents by class, antithrombotic agents, fenofibrates, and omega-3 fatty acids), cAdjusted for model B plus other on-treatment lipid parameters and baseline LDL-C levels.


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