The Association Between Non-traditional Lipid Parameters And Coronary Heart Disease With Diabetes

Background:In recent years,there is substantial evidence that patients with coronary atherosclerotic heart disease(CHD)combined with type 2 diabetes mellitus(T2DM)have significantly higher rates of death and disability than patients with CHD alone.The pathological basis of coronary heart disease is atherosclerosis.Since abnormal retention of lipids in the arterial intima can focally activate the arterial endothelium and trigger inflammatory responses in the arterial wall,leading to adhesion and aggregation of platelets and other inflammation-related cells,and eventually forming thrombi and leading to luminal narrowing,dyslipidemia plays an important role in the evolution of atherosclerosis.To strengthen the treatment target of dyslipidemia and improve the awareness,treatment and control rate of patients with dyslipidemia is of great significance to reduce the incidence of cardiovascular disease and death rate.A variety of lipid parameters have been proposed for lipid monitoring in China and abroad,and a large number of studies have confirmed the efficacy of non-traditional lipid parameters as predictors of coronary artery disease over single indicators.However,there are still few domestic studies on the correlation between non-traditional lipid parameters and patients with coronary artery disease combined with T2 DM,and most of them are done on the basis of statin drug therapy.Therefore,in the present study,we sought to assess the lipid markers most closely associated with the severity of coronary atherosclerosis in patients with coronary artery disease combined with T2 DM in a cohort of patients not receiving lipid-lowering therapy.Objective:To investigate the correlation study between non-traditional lipid parameters and CHD combined with T2 DM,with the aim of finding more sensitive lipid parameters for early clinical management of patients with coronary artery disease combined with T2 DM.Methods:A total of 440 patients admitted to hospital with coronary angiography for suspected coronary artery disease were selected and divided into CHD group(n=250)and non-CHD group(n=190)according to the results of the angiography.The CHD group was further divided into the CHD combined with T2 DM group(n=107),the CHD not combined with T2 DM group(coronary artery disease alone group,n=143),the T2 DM alone group(n=59),and the no disease group(n=131)according to whether they were combined with T2 DM.Finally,baseline data and serum indices were collected from the enrolled patients,and Non-High-Density Lipoprotein Cholesterol(non-HDL-C),serum Apolipoprotein B/serum Apolipoprotein A1(Apo B / Apo AI),Total Cholesterol/ High-Density Lipoprotein Cholesterol(TC / HDL-C),Triglycerides/ High-Density Lipoprotein Cholesterol(TG / HDL-C),Low-Density Lipoprotein Cholesterol/ High-Density Lipoprotein Cholesterol(LDL-C / HDL-C)and lipoprotein combine index(LCI)were calculated.The predictive value of nontraditional lipid parameters in patients with coronary artery disease complicated by diabetes was evaluated by intergroup comparison,linear regression,correlation analysis,and ROC curve analysis.Result:1.Patients in the coronary group were older,had a higher percentage of combined smoking,a higher percentage of combined T2 DM,and had less ventricular motion compared with the noncoronary group.and had significantly higher serum NT-pro BNP,creatinine(Cr),white blood cells(WBC),neutrophils(NE),monocytes(MONO),TG,non-HDL-C,TC/HDL-C,TG/HDL-C,LDL-C/HDL-C,and LCI,and significantly lower ALB,HDL-C,and APOA1/APOB.2.Compared with the CHD group alone,patients in the CHD combined with T2 DM group generally had more severe coronary artery lesions.The comparison of lipid levels among subgroups showed that HDL-C levels were significantly lower and TG/HDL-C and LDL-C/HDL-C were significantly higher in the CHD combined with T2 DM group compared with the other three groups.In addition,the non-HDL-C levels were significantly lower in the T2DM-only group compared with the other three groups.3.Binary logistic regression analysis showed that NT-pro BNP,HDL-C,APOA1/APOB,TC/HDL-C,and LCI were associated with the development of T2 DM in combination with coronary artery disease.4.Using Spearman and Pearson correlation analysis,the results showed that the severity of coronary lesions was positively correlated with NT-pro BNP,WBC,NE,MONO,CR,non-HDL-C,TC/HDL-C,TG/HDL-C,LDL-C/HDL-C(all P < 0.05)and positively correlated with HDL-C,APOA1/ APOB were negatively correlated.5.Multiple linear regression revealed that NE,MONO,CR,non-HDL-C,TC/HDLC,and LDL-C/HDL-C levels significantly and positively predicted the severity of coronary artery lesions,while HDL-C and NT-pro BNP levels negatively predicted the severity of coronary artery lesions.6.The predictive power of lipid markers on the development of T2 DM combined with coronary artery disease was evaluated using the subject operating characteristic curve(ROC curve)approach,and TG,TC/HDL-C,TG/HDL-C,LDL-C/HDL-C,and LCI were predictive of the occurrence of T2 DM in combination with coronary artery disease.The greatest AUC is TG/HDL-C,0.670(95% CI:0.624-0.714,P<0.001),had an ideal cut-off value of 1.1 and had predicted sensitivity and specificity values of 77.57% and51.65%,respectively.7.The predictive ability of ROC curve lipid parameters on the degree of coronary lesions in patients with coronary artery disease combined with T2 DM was found to be TC/HDL-C,LDL-C/HDL-C,and LCI levels on the degree of coronary lesions in patients with coronary artery disease combined with T2 DM,with the highest AUC of TC/HDLC,0.678(95% CI: 0.581-0.765,P = 0.002),the best cut-off value of 4.3,and predictive sensitivity and specificity of 68.97% and 69.23%.Conclusion:1.Various non-traditional lipid parameters are associated with the occurrence of T2 DM in combination with coronary artery disease,which can be used as a reference indicator to predict the complication of coronary artery disease in diabetic patients.2.Some non-traditional lipid parameters also showed a linear correlation with the degree of coronary artery disease in patients with coronary artery disease combined with T2 DM,which could significantly and positively predict the severity of coronary artery disease.3.Comparing the predictive ability of various lipid parameters on the degree of coronary artery disease in patients with coronary artery disease combined with T2 DM,The AUC of TC/HDL-C was the largest,0.678,and the best cut-off value was 4.3,with a predictive sensitivity of 68.97% and specificity of 69.23%,95% CI 0.581-0.765,P =0.002.