(12-09-11) Serum Level of Triglycerides Is a Potent Risk Factor Comparable to LDL Cholesterol for Coronary Heart Disease

Serum Level of Triglycerides Is a Potent Risk Factor Comparable to LDL Cholesterol for Coronary Heart Disease in Japanese Patients with Type 2 Diabetes: Subanalysis of the Japan Diabetes Complications Study (JDCS).
Sone H, Tanaka S, Tanaka S, Iimuro S, Oida K, Yamasaki Y, Oikawa S, Ishibashi S, Katayama S, Ohashi Y, Akanuma Y, Yamada N; for the Japan Diabetes Complications Study Group.
Source
Department of Internal Medicine (H.S.), University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan 310-0015; EBM Research Center (Sh.T.) and Translational Research Center (Sa.T.), Kyoto University School of Medicine, Kyoto, Japan 606-8507; Department of Biostatistics and Epidemiology (S.Ii., Y.O.), University of Tokyo School of Medicine, Tokyo, Japan 113-0033; Fukui Chuo Clinic (K.O.), Fukui, Japan 910-0023; Center for Advanced Science and Innovation (Y.Y.), Osaka University, Osaka, Japan 565-0871; Department of Medicine (S.O.), Nippon Medical School, Tokyo, Japan 113-8602; Department of Endocrinology and Metabolism (S.Is.), Jichi Medical College, Tochigi, Japan 329-0498; The Fourth Department of Medicine (S.K.), Saitama Medical School, Saitama, Japan 350-0495; The Institute for Adult Diseases Asahi Life Foundation (Y.A.), Tokyo, Japan 160-0023; and University of Tsukuba (N.Y.),305-0006.
Abstract
Context: Risk factors for cardiovascular complications in Japanese patients with diabetes have not been fully elucidated. Objective: Our objective was to determine incidence of and risk factors for coronary heart disease (CHD) and stroke in Japanese diabetic patients. Design and Settings: We conducted a prospective study at 59 hospitals throughout Japan. Patients: Patients included 940 men and 831 women with type 2 diabetes (mean age, 58.2 yr) without a history of cardiovascular complications who were followed for a median of 7.86 yr. Intervention: This was an observational study. Main Outcome Measures: Incidence of CHD and stroke was evaluated. Results: Incidences of CHD and stroke per 1000 person-years were 9.59 and 7.45, respectively, whereas those of myocardial and brain infarctions were 3.84 and 6.29, respectively. Multivariate Cox analysis revealed that the serum log-transformed triglyceride level was a potent and independent predictor of CHD [hazard ratio (HR) = 1.54; 95% confidence interval (CI) = 1.22-1.94 per 1 sd increase), comparable to low-density lipoprotein (LDL) cholesterol (HR = 1.49; 95% CI = 1.25-1.78 per 1 sd increase). Triglycerides and LDL cholesterol linearly and continuously increased CHD risk, and subjects in the top third for both had markedly high risks of CHD, and their effects were possibly additive. However, serum triglycerides worked independently of blood pressure levels. Systolic blood pressure was the only significant predictor for stroke except for age (HR = 1.31; 95% CI = 1.04-1.65, per 1 sd increase). Conclusions: In Japanese patients with type 2 diabetes, the serum triglyceride level was a leading predictor of CHD, comparable to LDL cholesterol. Because the serum triglyceride level is not a leading predictor of CHD in diabetic subjects in Western countries, ethnic group-specific strategies for prevention of diabetic macroangiopathy may be indicated

Source: J Clin Endocrinol Metab. 2011 Aug 24. [Epub ahead of print]

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