Comparison of cardiovascular prognosis between triglyceride variability and exposure estimate in diabetic patients

초록

Background and Aims : Serum triglyceride levels are an important lipid profile for dyslipidemia in diabetic patients. Recently, visit-to-visit variability of lipid profile has been suggested as a residual risk factor for cardiovascular disease. This study compared the impact on cardiovascular prognosis between the visit-to-visit variability and the cumulative exposure estimates of serum triglyceride in diabetic patients. Methods: A total of 13,414 patients, whose the 1st lipid profile measurement was taken between 2002 and 2007, measured 3 or more times, not prescribed for fibrate and omega-3 were selected from three tertiary hospitals. After excluding the patients with the prior myocardial infarction, stroke and malignancy history, 5,657 patients were finally analyzed. They were grouped based on their median values for the coefficient of variation (CV) and cumulative exposure estimate (CEE) of serum triglyceride levels during the 8-year modeling period. Incidence of major adverse cerebrocardiovascular event (MACCE), a composite of death, myocardial infarction (MI) and stroke, during the following 5 years were compared between groups after the propensity score matching. Results: The mean age was 65 years. High CEE group and high CV group showed younger, less hypertension and chronic kidney disease. Nevertheless, after the propensity score matching, the incidence of MACCE was higher in the high CV group compared to low CV group (9.26% vs 11.62%, log-rank p=0.02, Figure 1). On the other hand, it was similar between the high CEE group and low CEE group. Conclusions: Visit-to-visit variability of triglyceride rather than their cumulative exposure is more strongly related to the incidence of MACCE in diabetic patients.