1
|
Wang Y. Fasting Triglycerides in the Upper Normal Range Are Independently Associated with an Increased Risk of Diabetes Mortality in a Large Representative US Population. J Cardiovasc Dev Dis 2024; 11:128. [PMID: 38667746 PMCID: PMC11050947 DOI: 10.3390/jcdd11040128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
The association between normal-range triglyceride levels and diabetes mortality remains unclear. This cohort study aimed to elucidate this relationship by examining 19,010 US adult participants with fasting serum triglycerides below 150 mg/dL. Cox proportional hazards models were employed to estimate mortality hazard ratios (HRs) and 95% confidence intervals (CIs). Participants were followed up for a mean of 15.3 years, during which 342 diabetes deaths were recorded. A 1 natural log unit increase in triglycerides was associated with a 57% higher risk of diabetes mortality (adjusted HR, 1.57; 95% CI, 1.04-2.38). Comparable results were obtained when triglycerides were analyzed in quartiles. Receiver operating characteristic curve analysis identified an optimal triglyceride cutoff of 94.5 mg/dL for diabetes mortality; individuals with triglyceride levels above this threshold faced a greater risk of diabetes mortality (adjusted HR, 1.43; 95% CI, 1.12-1.83). Further investigation revealed a positive association between normal triglyceride levels and all-cause mortality, though no association was observed between normal triglycerides and mortality from hypertension or cardiovascular disease. In conclusion, elevated triglyceride levels within the normal range were associated with an increased risk of diabetes mortality. Individuals with triglyceride levels of 95 mg/dL or higher may require vigilant monitoring for diabetes and its associated complications.
Collapse
Affiliation(s)
- Yutang Wang
- Discipline of Life Science, Institute of Innovation, Science and Sustainability, Federation University Australia, Ballarat, VIC 3350, Australia
| |
Collapse
|
2
|
Wang Y, Fang Y, Vrablik M. Homeostasis Model Assessment for Insulin Resistance Mediates the Positive Association of Triglycerides with Diabetes. Diagnostics (Basel) 2024; 14:733. [PMID: 38611646 PMCID: PMC11011406 DOI: 10.3390/diagnostics14070733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Elevated circulating triglyceride levels have been linked to an increased risk of diabetes, although the precise mechanisms remain unclear. This study aimed to investigate whether low-density lipoprotein (LDL) cholesterol, homeostatic model assessment (HOMA) for insulin resistance, and C-reactive protein (CRP) served as mediators in this association across a sample of 18,435 US adults. Mediation analysis was conducted using the PROCESS Version 4.3 Macro for SPSS. Simple mediation analysis revealed that all three potential mediators played a role in mediating the association. However, in parallel mediation analysis, where all three mediators were simultaneously included, HOMA for insulin resistance remained a significant mediator (indirect effect coefficient, 0.47; 95% confidence interval [CI], 0.43-0.52; p < 0.05) after adjusting for all tested confounding factors. Conversely, LDL cholesterol (indirect effect coefficient, -0.13; 95% CI, -0.31-0.05; p > 0.05) and C-reactive protein (indirect effect coefficient, 0.01; 95% CI, -0.003-0.02; p > 0.05) ceased to be significant mediators. HOMA for insulin resistance accounted for 49% of the association between triglycerides and diabetes. In conclusion, HOMA for insulin resistance was the dominant mediator underlying the association between triglycerides and diabetes. Therefore, reducing triglyceride levels may hold promise for improving insulin sensitivity in diabetic patients.
Collapse
Affiliation(s)
- Yutang Wang
- Discipline of Life Science, Institute of Innovation, Science and Sustainability, Federation University Australia, Ballarat, VIC 3350, Australia
| | - Yan Fang
- Discipline of Life Science, Institute of Innovation, Science and Sustainability, Federation University Australia, Ballarat, VIC 3350, Australia
| | - Michal Vrablik
- Third Department of Medicine, General University Hospital and First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic;
| |
Collapse
|
3
|
Wang H, Wang C, Xuan X, Xie Z, Qiu Y, Qin H, Xiaoning Z. Association between triglyceride to high-density lipoprotein cholesterol ratio and type 2 diabetes risk in Japanese. Sci Rep 2023; 13:3719. [PMID: 36878958 PMCID: PMC9988840 DOI: 10.1038/s41598-022-25585-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/01/2022] [Indexed: 03/08/2023] Open
Abstract
Abnormal lipid metabolism is known to increases the risk for metabolic diseases, such as type 2 diabetes mellitus(T2DM). The relationship between baseline ratio of triglyceride to HDL cholesterol (TG/HDL-C) and T2DM in Japanese adults was investigated in this study. Our secondary analysis included 8419 male and 7034 female Japanese subjects who were free of diabetes at baseline. The correlation between baseline TG/HDL-C and T2DM was analyzed by a proportional risk regression model, the nonlinear correlation between baseline TG/HDL-C and T2DM was analyzed by a generalized additive model (GAM), and the threshold effect analysis was performed by a segmented regression model. We conducted subgroup analyses in different populations. During the median 5.39 years follow-up, 373 participants, 286 males and 87 females, developed diabetes mellitus. After full adjustment for confounders, the baseline TG/HDL-C ratio positively correlated with the risk of diabetes (hazard ratio 1.19, 95% confidence interval 1.09-1.3), and smoothed curve fitting and two-stage linear regression analysis revealed a J-shaped relationship between baseline TG/HDL-C and T2DM. The inflection point for baseline TG/HDL-C was 0.35. baseline TG/HDL-C > 0.35 was positively associated with the development of T2DM (hazard ratio 1.2, 95% confidence interval 1.10-1.31). Subgroup analysis showed no significant differences in the effect between TG/HDL-C and T2DM in different populations. A J-shaped relationship was observed between baseline TG/HDL-C and T2DM risk in the Japanese population. When TG/HDL-C was higher than 0.35, there was a positive relationship between baseline TG/HDL-C and the incidence of diabetes mellitus.
Collapse
Affiliation(s)
- Huijuan Wang
- Department of Respiratory, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.,Department of General Medicine, Guilin People's Hospital, The Fifth Affiliated Hospital of Guilin Medical University, Guilin, 541002, People's Republic of China
| | - Changming Wang
- Department of Respiratory Medicine, Guilin People's Hospital, The Fifth Affiliated Hospital of Guilin Medical University, Guilin, 541002, People's Republic of China
| | - Xiuping Xuan
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, People's Republic of China
| | - Zhouni Xie
- Department of General Medicine, Guilin People's Hospital, The Fifth Affiliated Hospital of Guilin Medical University, Guilin, 541002, People's Republic of China
| | - Yuanyuan Qiu
- Department of General Medicine, Guilin People's Hospital, The Fifth Affiliated Hospital of Guilin Medical University, Guilin, 541002, People's Republic of China
| | - Huiping Qin
- Department of Respiratory Medicine, Guilin People's Hospital, The Fifth Affiliated Hospital of Guilin Medical University, Guilin, 541002, People's Republic of China
| | - Zhong Xiaoning
- Department of Respiratory, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| |
Collapse
|
4
|
Wang Y, Fang Y, Magliano DJ, Charchar FJ, Sobey CG, Drummond GR, Golledge J. Fasting triglycerides are positively associated with cardiovascular mortality risk in people with diabetes. Cardiovasc Res 2022; 119:826-834. [PMID: 35905014 PMCID: PMC10153411 DOI: 10.1093/cvr/cvac124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS We investigated the association of fasting triglycerides with cardiovascular disease (CVD) mortality. METHODS AND RESULTS This cohort study included US adults from the National Health and Nutrition Examination Surveys from 1988 to 2014. CVD mortality outcomes were ascertained by linkage to the National Death Index records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of triglycerides for CVD mortality. The cohort included 26,570 adult participants, among which 3,978 had diabetes. People with higher triglycerides had a higher prevalence of diabetes at baseline. The cohort was followed up for a mean of 12.0 years with 1,492 CVD deaths recorded. A 1-natural-log-unit higher triglyceride was associated with a 30% higher multivariate-adjusted risk of CVD mortality in participants with diabetes (HR, 1.30; 95% CI, 1.08-1.56) but not in those without diabetes (HR, 0.95; 95% CI, 0.83-1.07). In participants with diabetes, people with high triglycerides (200-499 mg/dL) had a 44% (HR, 1.44; 95% CI, 1.12-1.85) higher multivariate-adjusted risk of CVD mortality compared with those with normal triglycerides (<150 mg/dL). The findings remained significant when diabetes was defined by fasting glucose levels alone, or after further adjustment for the use of lipid-lowering medications, or after the exclusion of those who took lipid-lowering medications. CONCLUSIONS This study demonstrates that fasting triglycerides of ≥200 mg/dl are associated with an increased risk of CVD mortality in patients with diabetes but not in those without diabetes. Future clinical trials of new treatments to lower triglycerides should focus on patients with diabetes.
Collapse
Affiliation(s)
- Yutang Wang
- Discipline of Life Science, School of Science, Psychology and Sport, Federation University Australia, Ballarat, VIC, 3350, Australia
| | - Yan Fang
- Discipline of Life Science, School of Science, Psychology and Sport, Federation University Australia, Ballarat, VIC, 3350, Australia
| | - Dianna J Magliano
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Fadi J Charchar
- Discipline of Life Science, School of Science, Psychology and Sport, Federation University Australia, Ballarat, VIC, 3350, Australia
| | - Christopher G Sobey
- Centre for Cardiovascular Biology and Disease Research and Department of Microbiology, Anatomy, Physiology & Pharmacology, School of Agriculture, Biomedicine & Environment, La Trobe University, Melbourne, VIC, Australia
| | - Grant R Drummond
- Centre for Cardiovascular Biology and Disease Research and Department of Microbiology, Anatomy, Physiology & Pharmacology, School of Agriculture, Biomedicine & Environment, La Trobe University, Melbourne, VIC, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, QLD, Australia
| |
Collapse
|
5
|
Early Prediction for Prediabetes and Type 2 Diabetes Using the Genetic Risk Score and Oxidative Stress Score. Antioxidants (Basel) 2022; 11:antiox11061196. [PMID: 35740093 PMCID: PMC9231325 DOI: 10.3390/antiox11061196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to use a genetic risk score (GRS) constructed with prediabetes and type 2 diabetes-related single nucleotide polymorphisms (SNPs) and an oxidative stress score (OSS) to construct an early-prediction model for prediabetes and type 2 diabetes (T2DM) incidence in a Korean population. The study population included 549 prediabetes and T2DM patients and 1036 normal subjects. The GRS was constructed using six prediabetes and T2DM-related SNPs, and the OSS was composed of three recognized oxidative stress biomarkers. Among the nine SNPs, six showed significant associations with the incidence of prediabetes and T2DM. The GRS was profoundly associated with increased prediabetes and T2DM (OR = 1.946) compared with individual SNPs after adjusting for age, sex, and BMI. Each of the three oxidative stress biomarkers was markedly higher in the prediabetes and T2DM group than in the normal group, and the OSS was significantly associated with increased prediabetes and T2DM (OR = 2.270). When BMI was introduced to the model with the OSS and GRS, the area under the ROC curve improved (from 69.3% to 70.5%). We found that the prediction model composed of the OSS, GRS, and BMI showed a significant prediction ability for the incidence of prediabetes and T2DM.
Collapse
|
6
|
Liu H, Liu J, Liu J, Xin S, Lyu Z, Fu X. Triglyceride to High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio, a Simple but Effective Indicator in Predicting Type 2 Diabetes Mellitus in Older Adults. Front Endocrinol (Lausanne) 2022; 13:828581. [PMID: 35282431 PMCID: PMC8907657 DOI: 10.3389/fendo.2022.828581] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/31/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A simple and readily available biomarker can provide an effective approach for the surveillance of type 2 diabetes mellitus (T2DM) in the elderly. In this research, we aim to evaluate the role of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as an indicator for new-onset T2DM in an elderly Chinese population aged over 75 years. METHODS This longitudinal retrospective cohort study was conducted using a free database from a health check screening project in China. Participants with baseline TG and HDL measurements were enrolled, and the data of T2DM development were collected. The cumulative incident T2DM rates in different quintile groups of TG/HDL-C ratio (Q1 to Q5) were calculated and plotted. The independent effect of baseline TG/HDL-C ratio on T2DM risk during the follow-up period was tested by the Cox proportional hazard model. Subgroup analysis was also conducted to clarify the role of TG/HDL-C ratio in specific populations. RESULTS A total of 231 individuals developed T2DM among 2,571 subjects aged over 75 years during follow-up. Regardless of adjustment for potential confounding variables, elevated TG/HDL-C ratio independently indicated a higher risk of incident T2DM [hazard ratio (HR) = 1.29; 95% confidence interval (CI), 1.14-1.47; P < 0.01. As compared with the lowest quintile (Q1), elevated TG/HDL-C ratio quintiles (Q2 to Q5) were associated with larger HR estimates of incident T2DM [HR (95% CI), 1.35 (0.85-2.17), 1.31 (0.83-2.06), 1.85 (1.20-2.85), and 2.10 (1.38-3.20), respectively]. In addition, a non-linear correlation was found between TG/HDL-C ratio and the risk of T2DM, and the slope of the curve decreased after the cutoff point of 2.54. Subgroup analysis revealed a stronger positive correlation among male individuals and those with body mass index <24 kg/m2. CONCLUSIONS Increased TG/HDL-C ratio indicates a greater risk of new-onset T2DM regardless of confounding variables. TG/HDL-C ratio is a simple but effective indicator in predicting T2DM in older adults. More future investigations are warranted to further promote the clinical application of TG/HDL-C ratio.
Collapse
Affiliation(s)
- Hongzhou Liu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Endocrinology, First Hospital of Handan City, Handan, China
| | - Jing Liu
- Clinics of Cadre, Department of Outpatient, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jixiang Liu
- Department of Cerebral Surgery, First Hospital of Handan City, Handan, China
| | - Shuanli Xin
- Department of Cardiology, First Hospital of Handan City, Handan, China
| | - Zhaohui Lyu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Xiaomin Fu, ; Zhaohui Lyu,
| | - Xiaomin Fu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Xiaomin Fu, ; Zhaohui Lyu,
| |
Collapse
|
7
|
Wang Y. Higher fasting triglyceride predicts higher risks of diabetes mortality in US adults. Lipids Health Dis 2021; 20:181. [PMID: 34930280 PMCID: PMC8686260 DOI: 10.1186/s12944-021-01614-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND It is unknown whether higher triglyceride results in higher mortality from diabetes, i.e., diabetes mortality. This study aimed to investigate the association of fasting triglyceride with diabetes mortality. METHODS This study included 26,582 US adults from the National Health and Nutrition Examination Surveys from 1988 to 2014. Diabetes mortality outcomes were ascertained by linkage to the National Death Index records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of triglyceride for diabetes mortality. RESULTS Higher levels of fasting triglyceride were associated with higher levels of glucose, glycated hemoglobin, insulin, and homeostatic model assessment for insulin resistance at baseline. A 1-natural-log-unit increase in triglyceride (e.g., from 70 to 190 mg/dL) was associated with a 115% higher multivariate-adjusted risk of diabetes diagnosis (odds ratio, 2.15; 95% CI, 2.00-2.33). During 319,758 person-years of follow-up with a mean follow-up of 12.0 years, 582 diabetes deaths were documented. Compared with people with triglyceride in the lowest quintile, people with triglyceride in the highest quintile had an 85% higher risk of diabetes mortality (HR, 1.85; 95% CI, 1.25-2.73). A 1-natural-log-unit increase in triglyceride was associated with a 40% higher multivariate-adjusted risk of diabetes mortality. The positive association between triglyceride and diabetes mortality was also presented in sub-cohorts of participants with or without diabetes. CONCLUSIONS This study demonstrated that higher fasting triglyceride was associated with a higher diabetes mortality risk.
Collapse
Affiliation(s)
- Yutang Wang
- Discipline of Life Sciences, School of Science, Psychology and Sport, Federation University Australia, University Drive, Mt Helen, VIC, 3350, Australia.
| |
Collapse
|
8
|
Tsou MT, Chang YC, Hsu CP, Kuo YC, Yun CH, Huang WH, Hu KC, Liu CY, Chen YJ, Sung KT, Liu CC, Hung CL, Kuo JY, Chen TY, Hung TC, Yeh HI. Visceral adiposity index outperforms conventional anthropometric assessments as predictor of diabetes mellitus in elderly Chinese: a population-based study. Nutr Metab (Lond) 2021; 18:87. [PMID: 34563209 PMCID: PMC8465784 DOI: 10.1186/s12986-021-00608-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/22/2021] [Indexed: 12/19/2022] Open
Abstract
Background This study assessed the performance of visceral adiposity index and body shape index in predicting diabetes mellitus (DM) risk and compared their predictive ability to that of body mass index and waist circumference. Methods Among 8249 consecutive subjects who attended the Nationwide Health Check Up System for Senior Citizens (≥ 65 years) between 2008 and 2018, we examined the associations of several adiposity indices with DM risk and explored gender differences. Results Among all adiposity indicators, Chinese visceral adiposity index (CVAI) demonstrated the highest discriminatory ability for diabetes mellitus with area under receiver operating characteristic curves (AUC) of 0.65, 0.68, and 0.66 for men, women, and all participants, respectively, and optimal cut-offs set as 126.09 in men and 117.77 in women. Compared with body shape index (ABSI), both CVAI and VAI were strongly associated with baseline DM (adjusted OR: 4.85, 95% CI: 4.05–5.82 and 4.22, 95% CI: 3.53–5.05 for 4th vs 1st quartile groups by CVAI and VAI, P < 0.001), which was more pronounced in older adult women (Pinteraction < 0.05). Over a median of 5.25 years (IQR: 3.07–6.44 years) follow-up, Cox regression models showed higher predictive ability of CVAI and VAI compared to ABSI. Further, both CVAI and VAI independently predicted new-onset DM (adjusted HR: 1.29, 95% CI: 1.22–1.37 and 1.16, 95% CI: 1.11–1.21 by CVAI and VAI) and composite endpoint of new DM and death among those without baseline DM.
Conclusions Our population-based data demonstrated that Chinese visceral adiposity index may serve as a superior clinical indicator of diabetes when compared with conventional anthropometric indices among older adult Chinese, especially in women. Supplementary Information The online version contains supplementary material available at 10.1186/s12986-021-00608-6.
Collapse
Affiliation(s)
- Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Department of Occupation Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,MacMacKay Junior College of Medicine, Nursing, and Management, Taipei City, 11260, Taiwan, ROC
| | - Yu-Chen Chang
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Department of Health Evaluation Center, MacKay Memorial Hospital, New Taipei City, 25245, Taiwan, ROC
| | - Ching-Ping Hsu
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Department of Health Evaluation Center, MacKay Memorial Hospital, New Taipei City, 25245, Taiwan, ROC
| | - Yang-Che Kuo
- Department of Health Evaluation Center, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC
| | - Chun-Ho Yun
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC.,Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC.,MacMacKay Junior College of Medicine, Nursing, and Management, Taipei City, 11260, Taiwan, ROC
| | - Wei-Hsin Huang
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Department of Occupation Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC
| | - Kuang-Chun Hu
- Department of Health Evaluation Center, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC.,Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC
| | - Chia-Yuan Liu
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC
| | - Ying-Ju Chen
- Department of Telehealth, MacKay Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Kuo-Tzu Sung
- Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC
| | - Chuan-Chuan Liu
- Department of Health Evaluation Center, MacKay Memorial Hospital, Taipei City, 10449, Taiwan, ROC
| | - Chung-Lieh Hung
- Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC
| | - Jen-Yuan Kuo
- Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC
| | - Tung-Ying Chen
- Department of Pathology, MacKay Memorial Hospital, 92, Sec 2, Chung Shan North Road, Taipei, 10449, Taiwan, ROC.
| | - Ta-Chuan Hung
- Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC. .,MacMacKay Junior College of Medicine, Nursing, and Management, Taipei City, 11260, Taiwan, ROC. .,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC.
| | - Hung-I Yeh
- Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan, ROC.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan, ROC
| |
Collapse
|
9
|
Yokote K, Yamashita S, Arai H, Araki E, Matsushita M, Nojima T, Suganami H, Ishibashi S. Effects of pemafibrate on glucose metabolism markers and liver function tests in patients with hypertriglyceridemia: a pooled analysis of six phase 2 and phase 3 randomized double-blind placebo-controlled clinical trials. Cardiovasc Diabetol 2021; 20:96. [PMID: 33947390 PMCID: PMC8097867 DOI: 10.1186/s12933-021-01291-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background Increased risk of cardiovascular events is associated not only with dyslipidemias, but also with abnormalities in glucose metabolism and liver function. This study uses pooled analysis to explore the in-depth effects of pemafibrate, a selective peroxisome proliferator-activated receptor α modulator (SPPARMα) already known to decrease elevated triglycerides, on glucose metabolism and liver function in patients with hypertriglyceridemia. Methods We performed a post-hoc analysis of six phase 2 and phase 3 Japanese randomized double-blind placebo-controlled trials that examined the effects of daily pemafibrate 0.1 mg, 0.2 mg, and 0.4 mg on glucose metabolism markers and liver function tests (LFTs). Primary endpoints were changes in glucose metabolism markers and LFTs from baseline after 12 weeks of pemafibrate treatment. All adverse events and adverse drug reactions were recorded as safety endpoints. Results The study population was 1253 patients randomized to placebo (n = 298) or pemafibrate 0.1 mg/day (n = 127), 0.2 mg/day (n = 584), or 0.4 mg/day (n = 244). Participant mean age was 54.3 years, 65.4 % had BMI ≥ 25 kg/m2, 35.8 % had type 2 diabetes, and 42.6 % had fatty liver. Fasting glucose, fasting insulin, and HOMA-IR decreased significantly in all pemafibrate groups compared to placebo. The greatest decrease was for pemafibrate 0.4 mg/day: least square (LS) mean change from baseline in fasting glucose − 0.25 mmol/L; fasting insulin − 3.31 µU/mL; HOMA-IR − 1.28. ALT, γ-GT, ALP, and total bilirubin decreased significantly at all pemafibrate doses vs. placebo, with the greatest decrease in the pemafibrate 0.4 mg/day group: LS mean change from baseline in ALT − 7.6 U/L; γ-GT − 37.3 U/L; ALP − 84.7 U/L; and total bilirubin − 2.27 µmol/L. Changes in HbA1c and AST did not differ significantly from placebo in any pemafibrate groups in the overall study population. The decreases from baseline in LFTs and glucose metabolism markers except for HbA1c were notable among patients with higher baseline values. FGF21 increased significantly in all pemafibrate groups compared to placebo, with the greatest increase in the pemafibrate 0.4 mg/day group. Adverse event rates were similar in all groups including placebo. Conclusions In patients with hypertriglyceridemia, pemafibrate can improve glucose metabolism and liver function, and increase FGF21, without increasing adverse event risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01291-w.
Collapse
Affiliation(s)
- Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan. .,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan.
| | - Shizuya Yamashita
- Rinku General Medical Center, 2-23 Ohrai-kita, Rinku, Izumisano-shi, Osaka, 598-8577, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-shi, Aichi, 474-8511, Japan
| | - Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan
| | - Mitsunori Matsushita
- Medical Affairs Department, Kowa Company, Ltd, 3-4-14 Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8433, Japan
| | - Toshiaki Nojima
- Clinical Data Science Department, Kowa Company, Ltd, 3-4-14 Nihonbashi-honcho, Chuo- ku, Tokyo, 103-8433, Japan
| | - Hideki Suganami
- Clinical Data Science Department, Kowa Company, Ltd, 3-4-14 Nihonbashi-honcho, Chuo- ku, Tokyo, 103-8433, Japan
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| |
Collapse
|
10
|
Zhang Y, Qin P, Lou Y, Zhao P, Li X, Qie R, Wu X, Han M, Huang S, Zhao Y, Liu D, Wu Y, Li Y, Yang X, Zhao Y, Feng Y, Wang C, Ma J, Peng X, Chen H, Zhao D, Xu S, Wang L, Luo X, Zhang M, Hu D, Hu F. Association of TG/HDLC ratio trajectory and risk of type 2 diabetes: A retrospective cohort study in China. J Diabetes 2020; 13:402-412. [PMID: 33074586 DOI: 10.1111/1753-0407.13123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/20/2020] [Accepted: 10/15/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The association of ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL-C ratio) change trajectory with risk of type 2 diabetes mellitus (T2DM) remains unknown. The aim of this study was to evaluate the association between risk of T2DM and TG/HDL-C ratio change trajectory. METHODS A total of 18 444 participants aged 18-80 years old were included in this cohort study. Linear regression and quadratic regression models were used to determine the TG/HDL-C ratio change trajectory. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between TG/HDL-C ratio change trajectory and probability of T2DM. RESULTS T2DM developed in 714 participants during a median follow-up of 5.74 years (92 076.23 person-years of follow-up). After adjusting for baseline potential confounders, odds of T2DM were greater for participants with the increasing, U-shape, bell-shape, and other shape change vs decreasing change (adjusted OR [aOR] 2.01, 95% CI 1.42-2.81; 1.56, 1.15-2.13; 1.60, 1.17-2.20; and 1.49, 1.13-2.00, respectively). The results were robust in the sensitivity analyses on excluding baseline participants with T2DM. Moreover, the associations remained significant with male sex, age <60 years and body mass index <24 kg/m2 . CONCLUSIONS This retrospective study revealed increased probability of T2DM with increasing, U-shape, bell-shape, and other-shape TG/HDL-C ratio change trajectories, especially with male sex, age <60 years and body mass index <24 kg/m2 .
Collapse
Affiliation(s)
- Yanyan Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Pei Qin
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Yanmei Lou
- Department of Health Management, Beijing Xiaotangshan Hospital, Beijing, People's Republic of China
| | - Ping Zhao
- Department of Health Management, Beijing Xiaotangshan Hospital, Beijing, People's Republic of China
| | - Xue Li
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, People's Republic of China
| | - Ranran Qie
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xiaoyan Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Minghui Han
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Shengbing Huang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yuying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Yang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Xingjin Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yifei Feng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Changyi Wang
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, People's Republic of China
| | - Jianping Ma
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, People's Republic of China
| | - Xiaolin Peng
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, People's Republic of China
| | - Hongen Chen
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, People's Republic of China
| | - Dan Zhao
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, People's Republic of China
| | - Shan Xu
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, People's Republic of China
| | - Li Wang
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease, Shenzhen, People's Republic of China
| | - Xinping Luo
- School of Basic Medicine, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Ming Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| | - Fulan Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, People's Republic of China
| |
Collapse
|
11
|
Zhao J, Zhang Y, Wei F, Song J, Cao Z, Chen C, Zhang K, Feng S, Wang Y, Li WD. Triglyceride is an independent predictor of type 2 diabetes among middle-aged and older adults: a prospective study with 8-year follow-ups in two cohorts. J Transl Med 2019; 17:403. [PMID: 31801571 PMCID: PMC6894231 DOI: 10.1186/s12967-019-02156-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background Although there is abundant evidence indicating the connection between triglyceride and type 2 diabetes mellitus (T2DM), few reports or cohort studies confirm that high TG concentration may predict the incidence of T2DM independently. Thus, we studied the association between triglyceride (TG) and T2DM in a male-dominated, middle and older aged cohort, Tianjin General Hospital Cohort. And we further verified our results in the China Health and Retirement Longitudinal Study (CHARLS). Methods We conducted an 8-year retrospective cohort study (2009–2017) with 7241 participants who were free from T2DM at baseline. Three groups were constructed based on baseline TG levels (normal, borderline-high, and high). We used a Cox proportional hazards model to evaluate the relationship between TG and T2DM after adjusting for possible risk factors. A Kaplan–Meier survival analysis was performed to compare the incidence of T2DM among subjects in each TG group. We also tested the association between TG and T2DM in the CHARLS cohort. Results In Tianjin General Hospital Cohort, 7241 participants (male 75.8%, female 24.2%) were included, mean age was 61.49 ± 13.85 years at baseline. The cumulative incidence of T2DM in our cohort study was 8.6% (9.2% in men and 6.6% in women). Compared with the normal TG group, the hazard ratios in the borderline and high group were 1.30 (95% CI 1.04–1.62) and 1.54 (95% CI 1.24–1.90). The Kaplan–Meier survival analysis indicated that higher TG levels may predict higher onset of T2DM. These results were verified in the CHARLS cohort, the hazard ratio with T2DM (95% CI) for logTG was 3.94 (2.64–5.87). Conclusions Our findings suggest that the TG level may be an independent risk factor and predictor for T2DM.
Collapse
Affiliation(s)
- Jing Zhao
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yuan Zhang
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Fengjiang Wei
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Jiani Song
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Zhi Cao
- College of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Chen Chen
- Tianjin General Hospital, Tianjin Medical University, 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Kai Zhang
- Tianjin General Hospital, Tianjin Medical University, 154 Anshan Road, Tianjin, 300052, People's Republic of China
| | - Shuzhi Feng
- Tianjin General Hospital, Tianjin Medical University, 154 Anshan Road, Tianjin, 300052, People's Republic of China.
| | - Yaogang Wang
- College of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.
| | - Wei-Dong Li
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.
| |
Collapse
|
12
|
Zhang M, Zhou J, Liu Y, Sun X, Luo X, Han C, Zhang L, Wang B, Ren Y, Zhao Y, Zhang D, Liu X, Hu D. Risk of type 2 diabetes mellitus associated with plasma lipid levels: The rural Chinese cohort study. Diabetes Res Clin Pract 2018; 135:150-157. [PMID: 29155120 DOI: 10.1016/j.diabres.2017.11.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/08/2017] [Accepted: 11/10/2017] [Indexed: 11/30/2022]
Abstract
AIM To investigate the association of type 2 diabetes mellitus (T2DM) risk and plasma lipid levels in rural Chinese. METHODS Each lipid variable was divided into quartiles and dichotomized by clinical cutoff points. Cox proportional-hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of T2DM risk and plasma lipid levels and explore the interaction between plasma lipid levels and other risk factors. RESULTS 11,929 participants were included in the analysis. We documented 720 incident cases of T2DM over 70,720.84 person-years of follow-up, for an incidence of 10.18/1,000 person-years. In the multivariable-adjusted model, risk of T2DM was increased with the highest versus lowest quartiles of total cholesterol (TC) and triglycerides (TG) levels and TC/high-density lipoprotein-cholesterol (HDL-C) and TG/HDL-C ratios. The HRs (95% CIs) for the fourth quartiles, for example, were 1.34 (1.03-1.74), 2.32 (1.73-3.13), 1.66 (1.23-2.25), and 1.84 (1.38-2.45), respectively. In addition, risk of T2DM was increased with high TG level and TC/HDL-C and TG/HDL-C ratios by clinical cutoffs. The HRs (95% CIs) were 1.50 (1.25-1.80), 1.24 (1.03-1.48), and 1.44 (1.18-1.75), respectively. Risk of T2DM was associated with interactions between all lipid variables and age and BMI. TG level and TG/HDL-C ratio additionally interacted with gender (all Pinteraction < 0.0001). CONCLUSIONS Risk of T2DM was increased with elevated serum levels of TC and TG and TC/HDL-C and TG/HDL-C ratios and also with interactions between high TC and TG levels and TC/HDL-C and TG/HDL-C ratios and age and BMI in a rural Chinese population.
Collapse
Affiliation(s)
- Ming Zhang
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China
| | - Junmei Zhou
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China
| | - Yu Liu
- The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, 47 Youyi Road, Shenzhen 518001, Guangdong, China
| | - Xizhuo Sun
- The Affiliated Luohu Hospital of Shenzhen University Health Sciences Center, 47 Youyi Road, Shenzhen 518001, Guangdong, China
| | - Xinping Luo
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China
| | - Chengyi Han
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, China
| | - Lu Zhang
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, China
| | - Bingyuan Wang
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, China
| | - Yongcheng Ren
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, China
| | - Yang Zhao
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, China
| | - Dongdong Zhang
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, China
| | - Xuejiao Liu
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, China
| | - Dongsheng Hu
- Department of Preventive Medicine, Shenzhen University Health Sciences Center, 3688 Nanhai Avenue, Shenzhen 518060, Guangdong, China.
| |
Collapse
|
13
|
Wang H, Guo X, Chen Y, Li Z, Xu J, Sun Y. Relation of four nontraditional lipid profiles to diabetes in rural Chinese H-type hypertension population. Lipids Health Dis 2017; 16:199. [PMID: 29020963 PMCID: PMC5637264 DOI: 10.1186/s12944-017-0590-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/04/2017] [Indexed: 01/09/2023] Open
Abstract
Background Mounting evidence suggested that nontraditional lipid profiles have been recognized as a reliable indicator for unfavorable cardiovascular events. The purpose of this study was to explore the role of nontraditional lipid profiles as potential clinical indices for the assessment of prevalent diabetes in rural Chinese H-type hypertension population. Methods During 2012 to 2013, we conducted a large cross-sectional study of 2944 H-type hypertension participants (≥35 years of age) from rural areas in northeast China. Subjects underwent accurate assessment of lipid profiles, fasting plasma glucose (FPG), homocysteine (Hcy) according to standard protocols. Results The proportion of diabetes showed a graded and linear increase across the quartiles for all four nontraditional lipid parameters. Nontraditional lipid variables were independent determinants of FPG, and its correlation for TG/HDL-C was strongest, whether potential confounders were adjusted or not. Multivariable logistic regression analysis established that the highest triglycerides (TG)/ high-density lipoprotein cholesterol (HDL-C) quartile manifested the largest ORs of prevalent diabetes (OR: 3.275, 95%CI: 2.109–5.087) compared with the lowest quartile. The fully adjusted ORs (95%CI) were 2.753 (1.783–4.252), 2.178 (1.415–2.351), 1.648 (1.097–2.478) for the top quartile of total cholesterol (TC)/HDL-C, low-density lipoprotein cholesterol (LDL-C)/HDL-C, and non-high-density lipoprotein cholesterol (non-HDL-C), respectively. On the basis of the area under receiver-operating characteristic curve (AUC), TG/HDL-C showed the optimal discriminating power for diabetes (AUC: 0.684, 95% CI: 0.650–0.718). Conclusions Nontraditional lipid profiles (TG/HDL-C, TC/HDL-C, LDL-C/HDL-C and non-HDL-C) were all consistently and independently correlated with prevalent diabetes among the H-type hypertension population in rural China. TG/HDL-C was prone to be more profitable in assessing the risk of prevalent diabetes and should be encouraged as an effective clinical tool for monitoring and targeted intervention of diabetes in H-type hypertension adults.
Collapse
Affiliation(s)
- Haoyu Wang
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yintao Chen
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Zhao Li
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Jiaqi Xu
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China.
| |
Collapse
|
14
|
Wang YL, Koh WP, Talaei M, Yuan JM, Pan A. Association between the ratio of triglyceride to high-density lipoprotein cholesterol and incident type 2 diabetes in Singapore Chinese men and women. J Diabetes 2017; 9:689-698. [PMID: 27573855 PMCID: PMC5332518 DOI: 10.1111/1753-0407.12477] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/15/2016] [Accepted: 08/28/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Increased triglycerides (TG) and decreased high-density lipoprotein cholesterol (HDL-C) are risk factors for type 2 diabetes (T2D). The relationship between TG:HDL-C ratio and T2D risk is not clear, and it is not known whether the association is modified by gender, body mass index, or fasting status. This study examined the relationship between TG:HDL-C ratio and risk of incident T2D, and the predictive ability of the ratio on top of other diabetes risk factors. METHODS Blood biomarkers were determined in 571 T2D cases and 571 controls nested within a prospective, population-based cohort study, the Singapore Chinese Health Study. Participants were free of diagnosed diabetes, cardiovascular disease, and cancer at the time of blood collection (1999-2004). Incident self-reported T2D cases were identified at follow-up interview (2006-10). Controls were matched 1: 1 for age, sex, dialect group, and date of blood collection. Multivariable logistic regression was used to compute the odds ratio (OR) and 95 % confidence interval (CI). RESULTS The ORs (95 % CI) of T2D per 1-SD increment in TG and TG: HDL-C ratio were 1.70 (1.39-2.09) and 1.72 (1.37-2.17), respectively. The relationships were stronger among females than males (Pinteraction = 0.028 and 0.017, respectively), and stronger among lean (<23 kg/m2 ) than overweight/obese participants (Pinteraction = 0.051 and 0.046, respectively). Both TG and TG: HDL-C improved T2D prediction to a similar degree. CONCLUSIONS Both TG and TG:HDL-C ratio are independent risk factors for incident T2D, and confer greater risk in women and lean participants. The TG: HDL-C ratio is not a better predictor of diabetes than TG alone.
Collapse
Affiliation(s)
- Ye-Li Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Republic of Singapore
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Republic of Singapore
- Duke-NUS Graduate Medical School Singapore, Republic of Singapore
| | - Mohammad Talaei
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Republic of Singapore
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - An Pan
- Department of Epidemiology and Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| |
Collapse
|
15
|
Oikawa S, Yamashita S, Nakaya N, Sasaki J, Kono S. Efficacy and Safety of Long-term Coadministration of Fenofibrate and Ezetimibe in Patients with Combined Hyperlipidemia: Results of the EFECTL Study. J Atheroscler Thromb 2017; 24:77-94. [PMID: 27397061 PMCID: PMC5225135 DOI: 10.5551/jat.35626] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/24/2016] [Indexed: 11/11/2022] Open
Abstract
AIM We investigated the safety and efficacy of a long-term combination therapy with fenofibrate and ezetimibe in Japanese patients with combined hyperlipidemia, in comparison with fenofibrate or ezetimibe alone. METHODS The study was a three-arm parallel-group, open-label randomized trial. Eligible patients were assigned to a combination therapy with fenofibrate (200 mg/day in capsule form or 160 mg/day in tablet form) and ezetimibe (10 mg/day), the fenofibrate monotherapy, or the ezetimibe monotherapy, which lasted for 52 weeks. The changes in serum low-density lipoprotein (LDL) cholesterol and triglycerides were the primary outcomes. RESULTS A total of 236 patients were assigned to one of the three treatments, and the number of patients included in the final analysis was 107 in the combination therapy, 52 in the fenofibrate monotherapy, and 51 in the ezetimibe monotherapy. Mean±SD changes in LDL cholesterol were -24.2%±14.7% with combination therapy, -16.0%±16.0% with fenofibrate alone, and -17.4%± 10.1% with ezetimibe alone. The combination therapy resulted in a significantly greater reduction in LDL cholesterol as compared with each monotherapy (p<0.01 for each). The corresponding values for triglycerides were -40.0%±29.5%, -40.1%±28.7%, and -3.4%±32.6%, respectively. Fenofibrate use was associated with some changes in laboratory measurements, but there was no differential adverse effect between the combination therapy and fenofibrate monotherapy. CONCLUSION The combination therapy with fenofibrate and ezetimibe substantially reduces concentrations of LDL cholesterol and triglycerides and is safe in a long-term treatment in Japanese patients with combined hyperlipidemia.
Collapse
Affiliation(s)
- Shinichi Oikawa
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Diabetes and Lifestyle Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan
| | - Shizuya Yamashita
- Department of Community Medicine & Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Rinku General Medical Center, Izumisano, Japan
| | | | - Jun Sasaki
- Department of Pharmaceutical Medicine, International University of Health and Welfare Graduate School of Health Sciences, Fukuoka, Japan
| | - Suminori Kono
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - for the Effect of Fenofibrate and Ezetimibe Combination Treatment on Lipid (EFECTL) Study Investigators
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Diabetes and Lifestyle Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan
- Department of Community Medicine & Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Rinku General Medical Center, Izumisano, Japan
- Nakaya Clinic, Tokyo, Japan
- Department of Pharmaceutical Medicine, International University of Health and Welfare Graduate School of Health Sciences, Fukuoka, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| |
Collapse
|
16
|
Janghorbani M, Amini M. Utility of serum lipid ratios for predicting incident type 2 diabetes: the Isfahan Diabetes Prevention Study. Diabetes Metab Res Rev 2016; 32:572-80. [PMID: 26663847 DOI: 10.1002/dmrr.2770] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/20/2015] [Accepted: 11/29/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND In this study, we evaluate the association between triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio and total cholesterol (TC) to HDL (TC/HDL) ratio and the risks of type 2 diabetes (T2D) in an Iranian high-risk population. METHODS We analysed 7-year follow-up data (n = 1771) in non-diabetic first-degree relatives of consecutive patients with T2D 30-70 years old. The primary outcome was the diagnosis of T2D based on repeated oral glucose tolerance tests. We used Cox proportional hazard models to estimate hazard ratio for incident T2D across tertiles of TG/HDL and TC/HDL ratios and plotted a receiver operating characteristic (ROC) curve to assess discrimination. RESULTS The highest tertile of TG/HDL and TC/HDL ratios compared with the lowest tertile was not associated with T2D in age- and gender-adjusted models (HR 0.99, 95% CI: 0.88, 1.11 for TG/HDL ratio and 1.10, 95% CI: 0.97, 1.23 for TC/HDL ratio). Further adjustment for waist circumference or body mass index, fasting plasma glucose, and low-density lipoprotein cholesterol did not appreciably alter the hazard ratio compared with the age- and gender-adjusted model. The area under the ROC curve for TG/HDL ratio was 57.7% (95% CI: 54.0, 61.5) and for TC/HDL ratio was 55.1% (95% CI: 51.2, 59.0). CONCLUSIONS TG/HDL and TC/HDL ratios were not robust predictors of T2D in high-risk individuals in Iran. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Mohsen Janghorbani
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
17
|
Nishikawa T, Okamura T, Shima A, Kawatsu Y, Sugiyama D, Kadota A, Morimoto A, Tatsumi Y, Godai K, Miyamatsu N. Casual serum triglyceride as a predictor of premature type 2 diabetes mellitus: an 8-year cohort study of middle-aged Japanese workers. Diabetol Int 2015; 7:252-258. [PMID: 30603271 DOI: 10.1007/s13340-015-0241-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/23/2015] [Indexed: 12/22/2022]
Abstract
Background The utility of casual serum triglyceride (TG) as a predictor of type 2 diabetes mellitus (DM) is unclear, especially during the most productive years. Methods Participants were 3271 workers (913 men and 2358 women, age 20-57) without DM at baseline. They underwent consecutive annual medical check-ups for 8 years. The association between newly diagnosed DM and casual serum TG level was determined by classifying the participants into 4 groups according to casual serum TG level at baseline: below 50 mg/dL (group A), 50-100 mg/dL (group B), 100-150 mg/dL (group C), and ≥150 mg/dL (group D). The effects of casual serum TG level in combination with sex, obesity, or serum glucose level on newly diagnosed DM were also evaluated. Results A total of 222 newly diagnosed type 2 DM cases with a mean age of 50 years old were observed during the follow-up period, i.e., 10/406 in group A, 66/1534 in group B, 58/712 in group C, and 88/619 in group D. Compared with group A, the odds ratio (ORs) for newly diagnosed DM (after adjusting for DM-associated factors) was found to increase with casual serum TG level: 1.38 (group B), 1.79 (group C), and 2.36 (group D). Moreover, the OR for newly diagnosed DM was higher in participants with high casual serum TG levels who were also male (OR 2.46), obese (OR 4.18), or had a high serum glucose level (OR 6.96) than in the reference group. Conclusions Serum TG level ≥150 mg/dL when fasting or nonfasting is a significant predictor of type 2 diabetes in middle-aged Japanese workers.
Collapse
Affiliation(s)
- Tomofumi Nishikawa
- 1Department of Health and Nutrition, Kyoto Koka Women's University, 38 Kadonocho, Nishikyogoku, Ukyo-Ku, Kyoto, 615-0822 Japan
- 4Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan
| | - T Okamura
- 2Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - A Shima
- Heiwado Co., Ltd., Hikone, Japan
- 4Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan
| | | | - D Sugiyama
- 2Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - A Kadota
- 5Osaka Kyoiku University, Osaka, Japan
| | - A Morimoto
- 4Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan
| | - Y Tatsumi
- 4Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan
- 6Department of Mathematical Health Science, Graduate School of Osaka University, Suita, Japan
| | - K Godai
- 4Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan
| | - N Miyamatsu
- 4Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan
| |
Collapse
|
18
|
Sung J, Lee K, Song YM, Lee M, Kim J. Genetic and baseline metabolic factors for incident diabetes and HbA(1c) at follow-up: the healthy twin study. Diabetes Metab Res Rev 2015; 31:376-84. [PMID: 25400114 DOI: 10.1002/dmrr.2619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/03/2014] [Accepted: 10/27/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND We investigated baseline anthropometric/metabolic traits predicting incident diabetes, genetic/environmental relationships between these traits and HbA1c at follow-up and the contribution of genetics, covariates and environments to variance in HbA(1c) at follow-up and incident diabetes. METHODS Nondiabetic twins (n = 869) and their family members (n = 949) were followed over 3.7 ± 1.4 years (44.3 ± 12.8 years of age); baseline anthropometric/metabolic traits were measured. Fasting plasma glucose and HbA(1c) were measured at follow-up. Incident diabetes was defined as HbA(1c) ≥6.5% or fasting plasma glucose ≥7 mmol/L. RESULTS Age-adjusted incident diabetes was 4.9% in men and 4.1% in women. Odd ratio for incident diabetes was 2.34-2.40, 1.25-1.28, 1.22-1.27 and 1.89 per standard deviation of baseline fasting plasma glucose, white blood cell (WBC), triglycerides and waist circumference, respectively, in multivariate generalized estimating equation models (p < 0.05). Age-adjusted and sex-adjusted heritability was 0.85 for diabetes and 0.72 for HbA(1c). In bivariate analyses adjusted for age, sex and body mass index at baseline, HbA1c at follow-up showed significant genetic and environmental correlations with baseline glucose (0.44, 0.17), significant genetic correlation with baseline waist circumference (0.16) and triglycerides (0.30) and significant environmental correlation with baseline WBC (0.09). Variance in HbA1c at follow-up and incident diabetes was explained by genetics (33% and 28%, respectively), covariates (36% and 48%, respectively), shared environments (7% and 0%, respectively) and errors (24% and 24%, respectively). CONCLUSIONS High values for baseline fasting plasma glucose, WBC, triglycerides and waist circumference are independent risk factors for incident diabetes. While genetic influences strongly contribute to variance in HbA1c at follow-up and incident diabetes, these risk factors significantly contribute to the remaining variance.
Collapse
Affiliation(s)
- Joohon Sung
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea; Institute of Health Environment, Seoul National University, Seoul, South Korea
| | | | | | | | | |
Collapse
|