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STUDY SUMMARY | |
Objective: | To determine associations between nephropathy and detailed serum lipoprotein subclass profiles in patients with type 1 diabetes. |
Study population: | 428 women and 540 men from the DCCT/EDIC study. |
Study design: |
Cross-sectional. |
Methods: |
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Results: |
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Author's conclusion: |
Potentially atherogenic lipoprotein profiles are associated with renal dysfunction in type 1 diabetes and further details are gained from NMR analysis. |
COMMENT
Using conventional lipid profile refined by NMR determination of lipoprotein subclasses, Jenkins et al. clearly demonstrated an association between several lipid abnormalities and diabetic nephropathy in patients with type 1 diabetes. An association between diabetic nephropathy and hypertriglyceridemia was found in both genders. In line with this finding, NMR measurements confirmed the association of diabetic nephropathy with triglyceride-rich VLDLs, mainly those of the smaller size. Although conventional lipid measurements did not point to HDL cholesterol (Table 1), NMR measurement showed an association of diabetic nephropathy with smaller HDL particles, which are not cardioprotective. More associations, in particular with a shift from larger toward smaller LDLs were found in men. Small, dense LDL particles have been reported to be more atherogenic than their large, “buoyant” counterparts, and are often associated with higher absolute number of LDL particles. The authors stress that the overall pattern of associations in men conforms to the atherogenic dyslipidemia which is a hallmark of insulin resistance, the metabolic syndrome, and type 2 diabetes. Due to its cross-sectional design, this study cannot tell whether dyslipidemia is a cause or an effect of diabetic nephropathy, or both. In a separate analysis published at a later date, the authors reported an association between dyslipoproteinemia and diabetic retinopathy.1 As they rightly stress, it is unlikely that diabetic retinopathy may affect whole-body plasma lipoprotein profile. Longitudinal studies are needed to determine whether lipoprotein-related intervention retard nephropathy.
Table 1. Relation between conventional lipid profile and albumin excretion rate in patients with type 1 diabetes |
||||
Conventional lipid profile |
Albumin excretion rate |
p value* |
||
<40 mg/24 h |
40-299 mg/24 (microalbuminuria) |
≥300 mg/24 h |
||
Total cholesterol | 187.1 ± 1.2 | 191.8 ± 3.5 | 212.8 ± 4.9 | <0.0001 |
Total triglycerides | 84.4 ± 2.1 | 94.0 ± 4.6 | 141.5 ± 11.6 | <0.0001 |
LDL cholesterol | 112.9 ± 1.0 | 120.3 ± 3.2 | 133.8 ± 4.8 | <0.002 |
HDL cholesterol | 56.8 ± 0.5 | 53.6 ± 1.5 | 56.2 ± 2.2 | NS |
*after adjustment on age, diabetes duration, hypertension, HbA1c, BMI, waist-to-hip ratio, and DCCT randomization group.
Further analyses revealed no significant differences between genders.
References |
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Key words | diabetic nephropathy; lipoproteins; lipoprotein subclasses |