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La interacción entre los lípidos sanguíneos y la EASC aumenta el riesgo de DKD: una relación no lineal se transforma
Huan Li1,2,3,4, Yulu Shi1,2,3, Hui Zhang2,3
1First Affiliated Hospital, Kunming Medical University, Kunming, China.
Frontiers in endocrinology
|September 5, 2025
Resumen
La enfermedad cardiovascular aterosclerótica amplifica los riesgos renales de colesterol alto y LDL-C en pacientes diabéticos, eliminando los umbrales protectores de lípidos. El tratamiento de los lípidos para la diabetes debe ser individualizado en función del estado de la EACV.
Área de la Ciencia:
- Cardiología
- Nefrología
- Endocrinología
Sus antecedentes:
- La enfermedad cardiovascular aterosclerótica (ASCVD) y la enfermedad renal diabética (DKD) están relacionadas con las complicaciones de la diabetes.
- La dislipidemia es un factor clave en su desarrollo.
- El impacto de la ASCVD en la relación lípido-DKD en pacientes diabéticos no tratados no está claro.
Objetivo del estudio:
- Investigar el efecto modificador de la ASCVD en la asociación entre los lípidos y el riesgo de DKD.
- Analizar los umbrales lipídicos para el riesgo de DKD en pacientes diabéticos con y sin ASCVD.
Principales métodos:
- Análisis retrospectivo de 26.476 pacientes diabéticos tipo 2 sin tratamiento para reducir los lípidos.
- Análisis de regresión y de spline cúbico restringido (RCS) para evaluar las asociaciones lípido-DKD.
- Evaluación de las interacciones multiplicativas y aditivas entre los lípidos y la EACV.
Principales resultados:
- El HDL-C mostró una asociación lineal con el DKD.
- Los umbrales significativos de lípidos para el riesgo de DKD (LDL-C, TC, TG, HDL-C) se encontraron sólo en pacientes sin ASCVD.
- Los pacientes con VSAC mostraron aumentos continuos de riesgo de DKD con TC y LDL-C, sin umbrales de seguridad.
- Las interacciones sinérgicas entre ASCVD y TC/LDL-C amplificaron los riesgos de lesión renal.
Conclusiones:
- La EACV agrava el daño renal causado por la TC y la LDL-C en pacientes diabéticos.
- ASCVD elimina los umbrales protectores de lípidos, lo que requiere un manejo individualizado de los lípidos.
- Se debe dar prioridad a un control estricto de la TC y de la LDL-C en pacientes diabéticos con ASCVD.
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