Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease

Kim, Mee Kyoung; Han, Kyungdo; Joung, Han Na; Baek, Kwang‐Hyun; Song, Ki‐Ho; Kwon, Hyuk‐Sang

doi:10.1186/s12933-019-0943-9

Cited by 33 publications

(27 citation statements)

References 43 publications

(52 reference statements)

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“…BMI was defined as participant weight in kilograms divided by the square of participant height in metres. Regular physical exercise was considered to be strenuous physical activity performed for at least 20 min more than once per week [19]. Economic status was dichotomised at the bottom 10%.…”

Section: How Might This Impact On Clinical Practice In the Foreseeablmentioning

confidence: 99%

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Improved oral hygiene is associated with decreased risk of new-onset diabetes: a nationwide population-based cohort study

Chang

Lee

et al. 2020

Diabetologia

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Aims/hypothesis Inflammation plays an important role in the development of diabetes, a major global health problem. Periodontal disease is also common in the general population. Because periodontal disease and poor oral hygiene can provoke transient bacteraemia and systemic inflammation, we hypothesised that periodontal disease and oral hygiene indicators would be associated with the occurrence of new-onset diabetes. Methods In this study we analysed data collected between 2003 and 2006 on 188,013 subjects from the National Health Insurance System-Health Screening Cohort (NHIS-HEALS) in Korea who had no missing data for demographics, past medical history, oral hygiene indicators or laboratory findings. The presence of periodontal disease was defined on the basis of a modified version of ICD-10 codes (Korean Classification of Disease, sixth edition), if claims for treatment for acute periodontitis (K052), chronic periodontitis (K053) and periodontosis (K054) were made more than two times by a dentist, or if, according to medical records, subjects received treatment by a dentist for periodontal disease with ICD-10 codes K052, K053 or K054. Oral hygiene behaviours (number of tooth brushings, a dental visit for any reason and professional dental cleaning) were collected as selfreported data of dental health checkups. Number of missing teeth was ascertained by dentists during oral health examination. The incidence of new-onset diabetes was defined according to ICD-10 codes E10-E14. The criterial included at least one claim per year for both visiting an outpatient clinic and admission accompanying prescription records for any glucose-lowering agent, or was based on a fasting plasma glucose ≥7 mmol/l from NHIS-HEALS. Results Of the included subjects, 17.5% had periodontal disease. After a median follow-up of 10.0 years, diabetes developed in 31,545 (event rate: 16.1%, 95% CI 15.9%, 16.3%) subjects. In multivariable models, after adjusting for demographics, regular exercise, alcohol consumption, smoking status, vascular risk factors, history of malignancy and laboratory findings, the presence of periodontal disease (HR 1.09, 95% CI 1.07, 1.12, p < 0.001) and number of missing teeth (≥15 teeth) remained positively associated with occurrence of new-onset diabetes (HR 1.21, 95% CI 1.09, 1.33, p < 0.001, p for trend <0.001). Frequent tooth brushing (≥3 times/ day) was negatively associated with occurrence of new-onset diabetes (HR 0.92, 95% CI 0.89, 0.95, p < 0.001, p for trend <0.001). Conclusions/interpretation Frequent tooth brushing may be an attenuating factor and the presence of periodontal disease and an increased number of missing teeth may be augmenting factors for the occurrence of new-onset diabetes. Improving oral hygiene may be associated with a decreased risk of occurrence of new-onset diabetes.

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Section: How Might This Impact On Clinical Practice In the Foreseeablmentioning

confidence: 99%

“…Criteria for this diagnosis included at least one claim per year for both visiting an outpatient clinic and admission accompanied by prescription records for any hypoglycaemic agents. Alternatively, at least one fasting plasma glucose ≥7 mmol/l result from NHIS-HEALS led to a diagnosis of new-onset diabetes [19].…”

Section: Definition Of New-onset Diabetesmentioning

confidence: 99%

Improved oral hygiene is associated with decreased risk of new-onset diabetes: a nationwide population-based cohort study

Chang

Lee

et al. 2020

Diabetologia

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“…Low-density lipoprotein cholesterol (LDL-C) is a well-established risk factor in the development of atherosclerotic cardiovascular disease (ASCVD). Several studies have shown unequivocal evidence that high levels of LDL-C have an unfavorable effect on ASCVD and contribute to cardiovascular death [ 1 – 3 ]. At present, statins are in addition to lifestyle interventions the first-line therapy for LDL-lowering, in addition to lifestyle interventions, in most patients.…”

Section: B Ackgroundmentioning

confidence: 99%

Real-world data on metabolic effects of PCSK9 inhibitors in a tertiary care center in patients with and without diabetes mellitus

Fischer

Hochfellner

Knoll

et al. 2021

Cardiovasc Diabetol

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Background The lipid-lowering and positive cardiovascular effect of proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors was shown in several studies, hence, they are more widely used in the lipid-lowering management of individuals with high cardiovascular risk. As real-world data are still scarce, specifically in patients with type 2 diabetes (T2D), the aim of this retrospective analysis was to investigate the efficacy of PCSK9 inhibitors in lowering low-density lipoprotein cholesterol (LDL-C) in an outpatient clinic of a tertiary care center in routine care. Methods A retrospective analysis of data extracted from the electronic patient record was performed. Patients who were routinely prescribed with PCSK9 inhibitor therapy (alirocumab or evolocumab) during the years 2016 and 2019 were included in the analysis. Characteristics of the patient population, the effects on LDL-C and HbA1c levels as well as subsequent cardiovascular events were assessed over an observation period of 18 months. Results We identified 237 patients treated with PCSK9 inhibitors between January 2016 and September 2019. Almost all patients (97.5%) received PCSK9 inhibitors for secondary prevention. 26.2% of the population had a concomitant diabetes diagnosis. Intolerance to statins (83.1%), ezetimibe (44.7%) or both agents (42.6%) was reported frequently. Three months after initiation of PCSK9 inhibitor therapy, 61.2% of the patients achieved LDL-C levels < 70 mg/dl, and 44.1% LDL-C levels < 55 mg/dl. The median LDL-C was lowered from 141 mg/dl at baseline, to 60 mg/dl after 3 months and 66 mg/dl after 12 months indicating a reduction of LDL-C as follows: 57.5% after 3 months and 53.6% after 12 months. After 3 months of observation, target achievement of LDL-C was higher in patients with T2D compared to non-diabetes patients; < 55 mg/dl: 51% vs. 41.5%; < 70 mg/dl 69.4 vs. 58.5%. After 12 months even more pronounced target LDL achievement in T2D was demonstrated < 55 mg/dl: 58.8% vs. 30.1%; < 70 mg/dl 70.6 vs. 49.6%. Patients with insufficiently controlled T2D (HbA1c > 54 mmol/mol) had a higher reduction in LDL-C but still were more likely to subsequent cardiovascular events. Conclusions Significant reductions in LDL-C and a high percentage of patients achieving recommended treatment targets were observed. The percentage of patients with T2D meeting recommended LDL-C targets was higher than in those without T2D. Still some patients did not achieve LDL-C levels as recommended in current guidelines. Special attention to the characteristics of these patients is required in the future to enable achievement of treatment goals and avoid adverse cardiovascular outcomes.

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“…Previous studies have demonstrated the consistency of high baseline lipid levels with the risk of CVD, coronary heart disease, and ischemic stroke 6 , 9 – 11 , 33 – 35 . The relationship between (apo)lipoproteins with CVD may be distinct in different populations such as younger individuals, women, and populations who achieved their LDL-C target 11 , 22 , 35 , 36 . Our data consistently suggested that younger populations with higher baseline lipid levels had significantly greater risks of CVD.…”

Section: Discussionmentioning

confidence: 99%

Association of baseline as well as change in lipid levels with the risk of cardiovascular diseases and all-cause deaths

Hsu

Tsai

Yeh

et al. 2021

Sci Rep

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High baseline atherogenic lipid level has been an established risk factor for the risk of cardiovascular events. Evidence concerning the role of lipid changes in cardiovascular and death risks are inconclusive. A cohort study was conducted based on the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (n = 4072, mean 44.8 years, 53.5% women) assessing lipid levels of the participants repeatedly measured in 2002 and 2007. Combined baseline and changes in lipid levels were classified into four groups—stable or decreasing lipid changes and increasing lipid changes with low- and high-risk baseline lipid levels. Developing cardiovascular events (n = 225) and all-cause deaths (n = 345) were ascertained during a median follow-up of 13.3 years. Participants with increasing and higher total cholesterol level were more likely to develop cardiovascular risks. Similar patterns for cardiovascular events were observed across other lipid profile changes. However, participants with increasing total cholesterol, LDL-C, and non-high-density lipoprotein cholesterol (non-HDL-C) levels were more likely to be at a lower risk for all-cause deaths. Baseline and changes in total cholesterol, triglycerides, and LDL-C levels were positively associated with the risk of cardiovascular diseases, whereas baseline and changes in total cholesterol and LDL-C and non-HDL-C levels were inversely associated with all-cause deaths.

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Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease

Cited by 33 publications

References 43 publications

Improved oral hygiene is associated with decreased risk of new-onset diabetes: a nationwide population-based cohort study

Improved oral hygiene is associated with decreased risk of new-onset diabetes: a nationwide population-based cohort study

Real-world data on metabolic effects of PCSK9 inhibitors in a tertiary care center in patients with and without diabetes mellitus

Association of baseline as well as change in lipid levels with the risk of cardiovascular diseases and all-cause deaths

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