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Circulation, Vol 88, 1421-1430, Copyright © 1993 by American Heart Association
M Laakso, S Lehto, I Penttila and K Pyorala
BACKGROUND. The aim of this study was to investigate the association of
lipoprotein fractions with the future risk of coronary heart disease (CHD)
in patients with non-insulin-dependent diabetes (NIDDM). METHODS AND
RESULTS. At baseline, lipoprotein fractions were determined in 313 diabetic
patients with NIDDM (153 men and 160 women), and these patients were
followed up for 7 years with respect to CHD events (CHD death or all CHD
events including CHD death or nonfatal myocardial infarction). Altogether,
56 NIDDM patients (28 men and 28 women) died from CHD and 25 had a nonfatal
myocardial infarction (17 men and 8 women) during the follow-up. NIDDM
patients having these CHD events during the follow-up had higher levels of
total and very-low-density lipoprotein (VLDL) triglycerides and VLDL
cholesterol and lower levels of high-density lipoprotein (HDL) and HDL2
cholesterol than those without CHD events. The risk for CHD death was
fourfold and for all CHD events, twofold higher among diabetics with low
HDL cholesterol (< 0.9 mmol/L) than among diabetics with HDL cholesterol
> or = 0.9 mmol/L. High triglyceride level (> 2.3 mmol/L) was
associated with a twofold increase in the risk of CHD events. In multiple
logistic regression analyses, HDL was inversely associated with CHD events
and VLDL triglycerides with CHD events in NIDDM patients with low HDL
cholesterol level (< or = 1.12 mmol/L). CONCLUSIONS. Our 7-year follow-
up study gives evidence that low HDL and HDL2 cholesterol, high VLDL
cholesterol, and high total and VLDL triglycerides are powerful risk
indicators for CHD events in patients with NIDDM.
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Lipids and lipoproteins predicting coronary heart disease mortality and morbidity in patients with non-insulin-dependent diabetes
Department of Medicine, Kuopio University Hospital, Finland.
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