Diabetes Metab J.  2024 Mar;48(2):265-278. 10.4093/dmj.2022.0443.

Risk of Cardiovascular Disease according to Baseline Low-Density Lipoprotein Cholesterol Level in Different Age Groups in Korean Diabetes Population: A Cohort Study

• Yoo TK
• Han KD
• Rhee EJ
• Lee WY

• KMID: 2553597
• DOI: http://doi.org/10.4093/dmj.2022.0443

Abstract

Background
The association between low-density lipoprotein (LDL-C) levels and cardiovascular disease (CVD) risk in different age groups within the diabetes mellitus (DM) population remains unclear. The cohort study was conducted to investigate this relationship.
Methods
We assessed the 2009 to 2012 Korean National Health Screening and National Health Insurance Service records, with follow-up to the primary outcome (myocardial infarction [MI] or stroke) or December 2018. After excluding the participants with a history of MI or stroke, 2,227,394 participants with DM were included and categorized according to baseline LDL-C levels and age. Cox proportional hazards modeling was conducted. The CVD risk of age <40 years and LDL-C <70 mg/dL was set as the reference. In each age group, LDL-C <70 mg/dL was used as a reference for the subgroup analysis.
Results
The cut-off LDL-C value for increased MI risk in each age group varied (<40 years old, LDL-C ≥160 mg/dL: hazard ratios [HR], 2.03; 95% confidence interval [CI], 1.644 to 2.506) (40–49-year-old, LDL-C <115 mg/dL: HR, 1.245; 95% CI, 1.04 to 1.489) (50–59-year-old, LDL-C <115 mg/dL: HR, 1.21; 95% CI, 1.014 to 1.445) (60-69-year-old, LDL-C <145 mg/dL: HR, 1.229; 95% CI, 1.022 to 1.479) (≥70 years old group, LDL-C <100 mg/dL: HR, 1.238; 95% CI, 1.018 to 1.504). The cut-off LDL-C values for increased stroke risk varied in each age subgroup (<40 years old, LDL-C ≥160 mg/dL: HR, 1.395; 95% CI, 1.094 to 1.779) (40–49-year-old, LDL-C <145 mg/dL: HR, 1.13; 95% CI, 1.019 to 1.253) (50–59-year-old, LDL-C <160 mg/dL: HR, 1.079; 95% CI, 1.008 to 1.154) (60–69-year-old, LDL-C <130 mg/dL: HR, 1.07; 95% CI, 1.022 to 1.119) (≥70 years old, LDL-C <115 mg/dL: HR, 1.064; 95% CI, 1.019 to 1.112).
Conclusion
The effect of LDL-C on the risk of CVD differs depending on the age of the population with DM.

Keyword

Aging; Cardiovascular diseases; Diabetes mellitus; Lipoproteins, LDL

Figure

• 

  Fig. 1. Flowdiagram of study participants. DM, diabetes mellitus; MI, myocardial infarction.

• 

Reference

1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020; 76:2982–3021.

2. Zibaeenejad F, Mohammadi SS, Sayadi M, Safari F, Zibaeenezhad MJ. Ten-year atherosclerosis cardiovascular disease (ASCVD) risk score and its components among an Iranian population: a cohort-based cross-sectional study. BMC Cardiovasc Disord. 2022; 22:162.

3. Schofield JD, Liu Y, Rao-Balakrishna P, Malik RA, Soran H. Diabetes dyslipidemia. Diabetes Ther. 2016; 7:203–19.

4. Hasheminasabgorji E, Jha JC. Dyslipidemia, diabetes and atherosclerosis: role of inflammation and ROS-redox-sensitive factors. Biomedicines. 2021; 9:1602.

5. American Diabetes Association Professional Practice Committee. 10. Cardiovascular disease and risk management: standards of medical care in diabetes-2022. Diabetes Care. 2022; 45(Suppl 1):S144–74.

6. Lind L, Sundstrom J, Arnlov J, Lampa E. Impact of aging on the strength of cardiovascular risk factors: a longitudinal study over 40 years. J Am Heart Assoc. 2018; 7:e007061.

7. Song SO, Jung CH, Song YD, Park CY, Kwon HS, Cha BS, et al. Background and data configuration process of a nationwide population-based study using the Korean National Health Insurance System. Diabetes Metab J. 2014; 38:395–403.

8. Rhee EJ, Kwon H, Park SE, Han KD, Park YG, Kim YH, et al. Associations among obesity degree, glycemic status, and risk of heart failure in 9,720,220 Korean adults. Diabetes Metab J. 2020; 44:592–601.

9. Cho JH, Kwon HM, Park SE, Jung JH, Han KD, Park YG, et al. Protective effect of smoking cessation on subsequent myocardial infarction and ischemic stroke independent of weight gain: a nationwide cohort study. PLoS One. 2020; 15:e0235276.

10. Kim MK, Han K, Joung HN, Baek KH, Song KH, Kwon HS. Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease. Cardiovasc Diabetol. 2019; 18:139.

11. American Diabetes Association Professional Practice Committee. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2022. Diabetes Care. 2022; 45(Suppl 1):S17–38.

12. Hur KY, Moon MK, Park JS, Kim SK, Lee SH, Yun JS, et al. 2021 Clinical practice guidelines for diabetes mellitus of the Korean Diabetes Association. Diabetes Metab J. 2021; 45:461–81.

13. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39:3021–104.

14. Ryan H, Trosclair A, Gfroerer J. Adult current smoking: differences in definitions and prevalence estimates: NHIS and NSDUH, 2008. J Environ Public Health. 2012; 2012:918368.

15. Hong JW, Noh JH, Kim DJ. The prevalence of and factors associated with high-risk alcohol consumption in Korean adults: the 2009-2011 Korea National Health and Nutrition Examination Survey. PLoS One. 2017; 12:e0175299.

16. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines for Americans. JAMA. 2018; 320:2020–8.

17. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020; 54:1451–62.

18. Kim YG, Jeong JH, Han KD, Roh SY, Min K, Lee HS, et al. Association between low-density lipoprotein cholesterol and sudden cardiac arrest in people with diabetes mellitus. Cardiovasc Diabetol. 2023; 22:36.

19. Mortensen MB, Nordestgaard BG. Elevated LDL-C cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years: a contemporary primary prevention cohort. Lancet. 2020; 396:1644–52.

20. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2019; 139:e1046–81.

21. Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2007; 115:114–26.

22. Roy-O’Reilly M, McCullough LD. Age and sex are critical factors in ischemic stroke pathology. Endocrinology. 2018; 159:3120–31.

23. Oesterle A, Laufs U, Liao JK. Pleiotropic effects of statins on the cardiovascular system. Circ Res. 2017; 120:229–43.

24. Shin DW, Cho J, Park JH, Cho B. National general health screening program in Korea: history, current status, and future direction. Precis Future Med. 2022; 6:9–31.

25. Kang YJ, Myong JP, Eom H, Choi B, Park JH, L Kim EA. The current condition of the workers’ general health examination in South Korea: a retrospective study. Ann Occup Environ Med. 2017; 29:6.

26. Kim YS, Ho SH. Factors associated with lack of health screening among people with disabilities using Andersen’s behavioral model. Healthcare (Basel). 2023; 11:656.

27. Kang HT. Current status of the national health screening programs in South Korea. Korean J Fam Med. 2022; 43:168–73.