LDL cholesterol as a strong predictor of coronary heart disease in diabetic individuals with insulin resistance and low LDL - The Strong Heart Study

Diabetes has been shown to increase the risk of coronary heart disease in a il populations studied. However, there is a lack of information on the rela tive importance of diabetes-associated risk factors for cardiovascular dise ase (CVD), especially the role of lipid levels, because low density lipopro tein (LDL) cholesterol often is not elevated in diabetic individuals. The o bjective of this analysis was to evaluate CVD risk factors, in a large coho rt of diabetic individuals and to compare the importance of dyslipidemia (i e, elevated triglycerides and low levels of high density lipoprotein [HDL] cholesterol) and LDL cholesterol in determining CVD risk in diabetic indivi duals. The Strong Heart Study assesses coronary heart disease and its risk factors in American Indians in Arizona, Oklahoma, and South/North Dakota. T he baseline clinical examinations (July 1989 to January 1992) consisted of a personal interview, physical examination, and drawing of blood samples fo r 4549 study participants (2034 with diabetes), 45 to 74 years of age. Foll ow-up averaged 4.8 years. Fatal and nonfatal CVD events were confirmed by s tandardized record review. Participants with diabetes, compared with those with normal glucose tolerance, had lower LDL cholesterol levels bur signifi cantly elevated triglyceride levels, lower HDL cholesterol levels, and smal ler LDL particle size. Significant independent predictors of CVD in those w ith diabetes included age, albuminuria, LDL cholesterol, HDL cholesterol (i nverse), fibrinogen, and.. percent body fat (inverse). A 10-mg/dL increase in LDL cholesterol was associated with a 12% increase in CVD risk. Thus, ev en at concentrations well below the National Cholesterol Education Program target of 130 mg/dL, LDL cholesterol is a strong independent predictor of c oronary heart disease in individuals with diabetes, even when components of diabetic dyslipidemia are present. These results support recent recommenda tions for aggressive control of LDL cholesterol in diabetic individuals, wi th a target level of <100 mg/dL.