Cardiovascular Outcomes according to Comorbidities and Low-Density Lipoprotein Cholesterol in Korean People with Type
Min Kyong Moon1, Junghyun Noh2, Eun-Jung Rhee3
1Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Insights
For Korean adults with type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD) risk increases with comorbidities like chronic kidney disease and hypertension. Lowering low-density lipoprotein cholesterol (LDL-C) targets is recommended for primary CVD prevention in these individuals.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Lack of specific cardiovascular (CV) risk categories and low-density lipoprotein cholesterol (LDL-C) treatment goals for Korean individuals with type 2 diabetes mellitus (T2DM).
- Need for data-driven recommendations tailored to the Korean population.
Purpose of the Study:
- To evaluate the incidence of cardiovascular disease (CVD) based on comorbidities in Korean adults with T2DM.
- To suggest appropriate LDL-C treatment goals for primary CVD prevention in this population.
Main Methods:
- Utilized the Korean National Health Insurance Service database, including 248,002 individuals with T2DM (aged 30-90) from 2009.
- Excluded subjects with prior CVD; followed participants from 2009 to 2018 for incident CVD (myocardial infarction, ischemic stroke).
Main Results:
- CVD incidence increased with diabetes duration (≥5 years), hypertension (HT), multiple CV risk factors (≥3), and chronic kidney disease (CKD).
- Linear increase in CVD risk observed from LDL-C levels ≥70 mg/dL in most T2DM patients.
- In T2DM patients without HT or with <5 years of diabetes, CVD risk increased from LDL-C levels ≥100 mg/dL.
Conclusions:
- Lowering LDL-C targets is beneficial for primary CVD prevention in Korean adults with T2DM, especially those with CKD, HT, longer diabetes duration, or multiple CV risk factors.
Background:
There are no clear data to support the cardiovascular (CV) risk categories and low-density lipoprotein cholesterol (LDL-C) treatment goals in Korean people with type 2 diabetes mellitus (T2DM). We evaluated the incidence of cardiovascular disease (CVD) according to comorbidities and suggested LDL-C treatment goals in Korean people with T2DM in nationwide cohort data.
Methods:
Using the Korean National Health Insurance Service database, 248,002 people aged 30 to 90 years with T2DM who underwent routine health check-ups during 2009 were included. Subjects with previous CVD were excluded from the study. The primary outcome was incident CVD, defined as a composite of myocardial infarction and ischemic stroke during the follow-up period from 2009 to 2018.
Results:
The mean age of the study participants was 59.6±10.9 years, and median follow-up period was 9.3 years. CVD incidence increased in the order of DM duration of 5 years or more (12.04/1,000 person-years), hypertension (HT) (12.27/1,000 personyears), three or more CV risk factors (14.10/1,000 person-years), and chronic kidney disease (18.28/1,000 person-years). The risk of incident CVD increased linearly from an LDL-C level of ≥70 mg/dL in most patients with T2DM. In T2DM patients without HT or with a DM duration of less than 5 years, the CVD incidence increased from LDL-C level of ≥100 mg/dL.
Conclusion:
For primary prevention of CVD in Korean adults with T2DM, it can be helpful to lower LDL-C targets when there are chronic kidney disease, HT, a long duration of diabetes mellitus, or three or more CV risk factors.
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