Barkas et al. J Cardiol. 2019 Mar 22 https://doi.org/10.1016/j.jjcc.2019.02.009

1. Atherogenic dyslipidemia increased the risk of incident diabetes in statin-
treated individuals
Barkas F (1), Elisaf M (1), Liberopoulos E (1), Liamis G (1), Ntzani E (2), Rizos EC (1,3)
(1) Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
(2) Department of Hygiene and Epidemiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
(3) Department of School of Medicine, European University of Cyprus, Nikosia, Cyprus
BACKGROUND
• Atherogenic dyslipidemia is associated with insulin resistance.
• Statin therapy increases the risk of incident diabetes (T2D), mostly in
those with insulin resistance.
AIM
• We aimed to investigate which metabolic factors, including atherogenic
dyslipidemia, increase the risk of incident T2D in statin-treated
individuals.
METHODS
• This was an observational study conducted in Greece including 1,241
dyslipidemic individuals attending a lipid clinic and followed-up for >3
years.
• After defining the predictors for incident T2D, we assessed the risk of
new-onset T2DM based on the presence of
• prediabetes (PreDM; glucose:100-125 mg/dL)
• mixed dyslipidemia [MixDys; triglycerides (TG) <200 mg/ dL and high-
density lipoprotein cholesterol (HDL-C) <40 or <50 mg/dL, for males
and females respectively].
RESULTS
RESULTS
• Baseline patients’ age (OR: 1.05; 95% CI: 1.02-1.08, p <0.01)
• family history of diabetes (OR: 3.58; 95% CI: 1.86-6.91, p <0.01)
• IFG (OR: 6.56; 95% CI: 3.53-12.12, p <0.01)
• overweight/obesity (OR: 2.65; 95% CI: 1.39-5.05, p <0.01)
• atherogenic dyslipidemia (OR: 3.27; 95% CI: 1.50-7.15, p <0.01)
• treatment with high-intensity statins (OR: 3.51; 95% CI: 1.89-6.51,
p <0.01)
were defined as independent factors for incident T2D
• Atherogenic dyslipidemia appears to be an independent risk factor for
new-onset T2D in statin-treated patients, while PreDM,
overweight/obesity and family history of diabetes remain risk factors for
new-onset T2D in this group.
With thanks to the EAS for support in the form of a Young Investigator Fellowship
• After excluding 166 patients with baseline T2D and 193 subjects taking
lipid-lowering therapy at the baseline visit,
• 11% of the eligible subjects (n=882) developed T2D during their
follow-up (6 years; IQR:4-10).
CONCLUSIONS
Baseline Variables Comparator group Incident diabetes
N 788 94
Gender, male (%) 57 61*
Age (years) 54 (46-62) 59 (54-64)
Family history of diabetes (%) 14 28 *
Metabolic syndrome (%) 34 77 *
Impaired fasting glucose (%) 26 75 *
Body mass index ≥25 kg/m2 (%) 50 76 *
Hypertension (%) 56 72 *
Triglycerides ≥200 mg/dL (%) 19 36 *
Low high-density lipoprotein
cholesterol levels (%)
25 42 *
Mixed dyslipidemia (%) 8 24 *
Systolic blood pressure (mmHg) 140 (125-150) 150 (138-160)
Diastolic blood pressure (mmHg) 87 (80-95) 90 (80-100)
Body mass index (kg/m2) 27.1 (24.6-29.7) 29.2 (27.3-32.2) *
Fasting plasma glucose (mg/dL) 93 (86-100) 108 (99-117)
Total cholesterol (mg/dL) 261 (232-297) 257 (214-293)
Triglycerides (mg/dL) 127 (92-181) 148 (102-233) *
• p <0,05 for the comparison the comparator group
* p <0.05 for the comparison with those with neither PreDM nor atherogenic dyslipidemia
6.9
18.6
0
2
4
6
8
10
12
14
16
18
20Ratesofincidentdiabetes,%
Atherogenic dyslipidemia and risk of incident diabetes
Without MixDys With MixDys
*
* p <0.05 for the comparison with those with atherogenic dyslipidemia
Adjusted OR: 3.27 (1.50-7.15), p <0.01
• Subjects with PreDM and MixDys exhibited the highest risk of
T2DMcompared with the normoglycemic individuals without MixDys
(Adjusted OR: 21.01; 95% CI: 7.64-57.78, p <0.01)
*
*
*
3.8
21.1
5.5
35.7
0
5
10
15
20
25
30
35
40
FPG <100 mg/dL (n=606) FPG 100-125 mg/dL (n=276)
RatesofincidentT2D,%
Hyperlipidemic patients (n=793) Patients with MixDys (n=89)
*
*
*