Association between serum LDL-C concentrations and risk of diabetes: A prospective cohort study

Jiaojiao Huang; Hong Lin; Shuangyuan Wang; Mian Li; Tiange Wang; Zhiyun Zhao; Yu Xu; Min Xu; Jieli Lu; Yuhong Chen; Guang Ning; Weiqing Wang; Yufang Bi; Long Wang

doi:10.1111/1753-0407.13440

Association between serum LDL-C concentrations and risk of diabetes: A prospective cohort study

J Diabetes. 2023 Oct;15(10):881-889. doi: 10.1111/1753-0407.13440. Epub 2023 Jul 17.

Authors

Jiaojiao Huang^{1

2}, Hong Lin^{1

2}, Shuangyuan Wang^{1

2}, Mian Li^{1

2}, Tiange Wang^{1

2}, Zhiyun Zhao^{1

2}, Yu Xu^{1

2}, Min Xu^{1

2}, Jieli Lu^{1

2}, Yuhong Chen^{1

2}, Guang Ning^{1

2}, Weiqing Wang^{1

2}, Yufang Bi^{1

2}, Long Wang^{1

2}

Affiliations

¹ Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, Shanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract
in English, Chinese

Background: Low-density lipoprotein cholesterol (LDL-C) and diabetes mellitus are both modifiable risk factors for cardiovascular disease; however, whether elevated LDL-C levels confer a risk for diabetes remains unclear.

Objective: We aimed to examine the association between serum LDL-C concentrations at baseline and the risk of developing diabetes at follow-up in the general population of Chinese adults.

Methods: This study included 5274 adults aged ≥ 40 years from a community cohort who were without diabetes and followed for a median of 4.4 years. A standard 75-g oral glucose tolerance test was conducted at baseline and follow-up visits to diagnose diabetes. Logistic regression models and a restricted cubic spline were used to examine the association between baseline serum LDL-C levels and the risk of diabetes development. Subgroup analyses were conducted stratifying on age, sex, body mass index, hypertension, family history of diabetes, and LDL-C levels.

Results: A total of 652 participants (12%) developed diabetes during the follow-up period. Compared to quartile 1 of serum LDL-C, quartiles 2, 3, and 4 were associated with a 30%, 33%, and 30% significantly higher risk of diabetes, respectively after adjustment for confounders including homeostatic model assessment for insulin resistance. The linear relationship between baseline LDL-C down to 30.1 mg/dL and incident diabetes was demonstrated by restricted cubic spline analysis, and each 1-SD increase in LDL-C concentration (28.5 mg/dL) was associated with a 12% increase in the risk of diabetes (odds ratio 1.12, 95% confidence interval 1.03-1.22).

Conclusion: In this community-based general population, higher serum LDL-C levels were linearly associated with an elevated risk of incident diabetes.

背景: 低密度脂蛋白胆固醇(LDL-C)和糖尿病都是心血管疾病的可改变风险因素; 然而，升高LDL-C水平是否会带来糖尿病的风险仍不清楚。本文旨在探讨在中国成年人中的基线血清LDL-C浓度与随访期间糖尿病风险之间的关联。方法: 本研究包括5274名基线年龄≥40岁的社区队列参与者，他们无糖尿病且中位随访时间为4.4年。在基线和随访期间进行75g口服糖耐量试验以诊断糖尿病。使用逻辑回归模型和限制性立方样条来探讨基线血清LDL-C水平与糖尿病风险之间的关联。根据年龄、性别、BMI、高血压、糖尿病家族史和LDL-C水平进行亚组分析。结果: 在随访期间，共有652名(12%)参与者发生糖尿病。校正包括HOMA-IR在内的混杂因素后，与血清LDL-C四分位组1相比，四分位组2、3和4的糖尿病风险分别显著增加30%、33%和30%。限制性立方样条分析显示基线LDL-C降至30.1mg/dl与糖尿病发病之间存在线性关系，LDL-C浓度每增加1个标准差(28.5mg/dl)，糖尿病发病风险增加12% (OR 1.12, 95%CI 1.03 ~ 1.22)。结论: 在基于社区的一般人群中，血清LDL-C水平升高与新发糖尿病的风险增加呈线性关系。.

Keywords: LDL-C; diabetes mellitus; prospective; risk; 前瞻性; 糖尿病; 风险.

Abstract in English, Chinese

Grants and funding

Abstract
in English, Chinese