Abstract 12901: Non-LDL Dyslipidemia : The Neglected Side of Lipid-Related Residual Risk in T2DM
Background. The hallmark of atherogenic dyslipidemia (AD) is the combined occurrence of raised triglycerides (TG) plus low HDL-C. Epidemiological/intervention trials have established that AD is a key comorbid state which contributes to residual vascular risk (RVR) in type 2 diabetes (T2DM), even with LDL-C and glycemia at target. Data from ACCORD Lipid demonstrate that AD-related RVR in T2DM can be substantially decreased by addition of fenofibrate on top of statin therapy. Yet, screening for AD is not routinely performed due to lack of agreement on cut-offs, and to frequent non-availability of baseline HDL-C and TG levels, prior to lipid-lowering drugs (LLD). Methods. We investigated AD prevalence in 974 Caucasian T2DM patients attending an academic diabetes clinic. To establish the true, unbiased presence of AD, co-occurrence of low HDL-C/high TG was determined using cut-offs from the consensual definition of the metabolic syndrome [HDL-C: 40 mg/dL (males); 50 mg/dL (females); TG: 150 mg/dL]. Sixty-five % (n=633) were on LLD(s): statins (53%); fenofibrate (21%); and/or ezetimibe (3%). In untreated patients (n=341), current HDL-C and TG values were analyzed to calculate AD prevalence, whereas pristine, pre-LLD values were used in patients on LLD. Results. The unbiased AD prevalence was high, at 35% in both genders. In the overall cohort, HDL-C [mean (1SD)] was 47 (14) mg/dL, and TG were 167 (120) mg/dL, with low HDL-C prevalent in 51%, and high TG in 52%. In patients on LLD, mean pre-LLD TG were 203 mg/dL, representing an average difference of 36 mg/dL (18%) vs. post-LLD values, large enough to underestimate AD prevalence based upon current lipids only. Differences between genders were observed for HDL-C [44 (13) [males] vs. 52 (15) mg/dL [females]; p<0.0001], and apolipoprotein A-I [143 (28) vs. 163 (31) mg/dL; p<0.0001]. Females had lower AD ratio [log(TG)/HDL-C]: 0.046 (0.021) vs. 0.054 (0.026) in males (p<0.0001). Conclusions. Using strict baseline, gender-adjusted criteria, we found a high prevalence of AD (35%) in T2DM patients. Such a high figure translates into a clearly unmet need in managing lipid-related RVR, as most T2DM patients with AD are left untreated as regards non-LDL dyslipidemia, being at best on statin monotherapy rather than dual treatment.
- © 2012 by American Heart Association, Inc.