Résumé
To investigate whether elevated triglycerides and low high-density lipoprotein (HDL) cholesterol (atherogenic dyslipidemia) are predictive of risk for silent myocardial ischemia (SMI) or angiographic coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes.
Cohort study in 1080 asymptomatic patients with type 2 diabetes, a normal 12-lead resting electrocardiogram (ECG), at least one additional cardiovascular risk factor and low density lipoprotein (LDL) cholesterol <3.4mmol/L. Patients initially underwent screening for SMI by 201thallium myocardial scintigraphy after an ECG stress test, a pharmacological stress test (dipyridamole injection), or both. Patients with SMI underwent coronary angiography.
SMI was detected in 292 patients and CAD in 91 patients. Overall, 60 (5.5%) patients had atherogenic dyslipidemia (triglycerides ≥2.04g/lmmol/L and HDL cholesterol ≤0,34g/l), which was associated with SMI (40.0 vs 26.3%, p<0.001) and CAD (22.2 vs 8.3%, p<0.001). In multivariate analyses taking into account the parameters associated in univariate analyses with SMI and then CAD, SMI was associated with atherogenic dyslipidemia (odds ratio 1.8[1.0–3.3]), male gender (OR 2.1[1.5–2.9]), BMI (OR 0.97[0.94–1.00]), retinopathy (OR 1.4[1.1–1.9]), peripheral occlusive arterial disease (POAD: OR 2.5[1.6–3.8]) and mean blood pressure (OR 1.01[1.00–1.03]); CAD was associated with atherogenic dyslipidemia (OR 4.0[1.7–9.2]), male gender (OR 3.0[1.6–5.6]), BMI (OR 0.94[0.90–1.00]), retinopathy (OR 1.7[1.0–2.9], POAD (OR 4.0[2.1–7.4]) and mean blood pressure (OR 1.03[1.01–1.05]). In the subgroup of 584 patients at LDL cholesterol <2.6mmol/L, CAD was also independently associated with atherogenic dyslipidemia (2.96 [0.97–9.03], p=0.06).
In type 2 diabetic patients including those at LDL cholesterol goal, atherogenic dyslipidemia is associated with an increased risk of silent CAD. Management targeted to this dyslipidemic profile may help to reduce the high residual burden of cardiovascular disease.