Advanced lipoprotein profle disturbances in type 1 diabetes mellitus: a focus on LDL particles

Abstract

Background: Lipoprotein disturbances have been associated with increased cardiovascular disease (CVD) risk in type 1 diabetes mellitus (T1DM). We assessed the advanced lipoprotein profle in T1DM individuals, and analysed diferences with non-diabetic counterparts. Methods: This cross-sectional study involved 508 adults with T1DM and 347 controls, recruited from institutions in a Mediterranean region of Spain. Conventional and advanced (assessed by nuclear magnetic resonance [NMR] spectroscopy) lipoprotein profles were analysed. Crude and adjusted (by age, sex, statin use, body mass index and leukocyte count) comparisons were performed. Results: The median (interquartile range) age of the study participants was 45 (38–53) years, 48.2% were men. In the T1DM group, the median diabetes duration was 23 (16–31) years, and 8.1% and 40.2% of individuals had nephropathy and retinopathy, respectively. The proportion of participants with hypertension (29.5 vs. 9.2%), and statin use (45.7% vs. 8.1%) was higher in the T1DM vs. controls (p<0.001). The T1DM group had a better conventional (all parameters, p<0.001) and NMR-lipid profle than the control group. Thus, T1DM individuals showed lower concentrations of atherogenic lipoproteins (VLDL-particles and LDL-particles) and higher concentrations of anti-atherogenic lipoproteins (HDL-particles) vs. controls, even after adjusting for several confounders (p<0.001 for all). While non-diabetic women had a more favourable lipid profle than non-diabetic men, women with T1DM had a similar concentration of LDL-par‑ ticles compared to men with T1DM (1231 [1125–1383] vs. 1257 [1128–1383] nmol/L, p=0.849), and a similar concentration of small-LDL-particles to non-diabetic women (672.8 [614.2–733.9] vs. 671.2 [593.5–761.4] nmol/L, respectively; p=0.790). Finally, T1DM individuals showed higher discrepancies between NMR-LDL-particles and conventional LDLcholesterol than non-diabetic subjects (prevalence of LDL-cholesterol<100 mg/dL & LDL-particles>1000 nmol/L: 38 vs. 21.2%; p<0.001). All these diferences were largely unchanged in participants without lipid-lowering drugs (T1DM, n=275; controls, n=317).

This research was supported by grants from the Carlos III National Institute of Health (PI12/0183 and PI15/0625). CIBER for Diabetes and Associated Metabolic Diseases (CIBERDEM) and CIBER on Pathophysiology of Obesity and Nutrition (CIBEROBN) are initiatives of ISCIII, Spain. AJA received a research grant from the Associació Catalana de Diabetis (ACD), “Ajut per a la recerca en diabetis modalitat clínica 2018”.