Triglyceride-cholesterol imbalance across lipoprotein subclasses predicts diabetic kidney disease and mortality in type 1 diabetes: the FinnDiane Study
Article first published online: 18 JAN 2013
© 2012 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 273, Issue 4, pages 383–395, April 2013
How to Cite
University of Oulu, Oulu; Biomedicum Helsinki, Helsinki; Helsinki University Central Hospital, Helsinki, Finland; Central South University, Hunan Province, China; University of Eastern Finland, Kuopio; University of Turku and Turku University Hospital, Turku; University of Oulu, Oulu, Finland; Baker IDI Heart and Diabetes Institute, Melbourne, Australia. Triglyceride-cholesterol imbalance across lipoprotein subclasses predicts diabetic kidney disease and mortality in type 1 diabetes: the FinnDiane Study. J Intern Med 2013; doi: 10.1111/joim.12026, , , , , , , , , ,
- Issue published online: 20 MAR 2013
- Article first published online: 18 JAN 2013
- Accepted manuscript online: 19 DEC 2012 11:10PM EST
- Folkhälsan Research Foundation. Grant Numbers: FP7/2007-2013, 223211, 137870, 129269, 129429
- University of Oulu. Grant Numbers: FP7/2007-2013, 223211, 137870, 129269, 129429
- Wilhelm and Else Stockmann Foundation
- Liv och Hälsa Foundation
- European Community. Grant Numbers: FP7/2007-2013, 223211
- Orion-Farmos Research Foundation
- Finnish Foundation for Cardiovascular Research
- Jenny and Antti Wihuri Foundation
- Academy of Finland. Grant Number: 137870
- Academy of Finland. Grant Numbers: 129269, 129429
- lipoprotein subclasses;
- proton NMR;
- type 1 diabetes
Circulating cholesterol (C) and triglyceride (TG) levels are associated with vascular injury in type 1 diabetes (T1DM). Lipoproteins are responsible for transporting lipids, and alterations in their subclass distributions may partly explain the increased mortality in individuals with T1DM.
Design and subjects
A cohort of 3544 individuals with T1DM was recruited by the nationwide multicentre FinnDiane Study Group. At baseline, six very low-density lipoprotein VLDL, one intermediate-density lipoprotein IDL, three low-density lipoprotein LDL and four higher high-density lipoprotein HDL subclasses were quantified by proton nuclear magnetic resonance spectroscopy. At follow-up, the baseline data were analysed for incident micro- or macroalbuminuria (117 cases in 5.3 years), progression from microalbuminuria (63 cases in 6.1 years), progression from macroalbuminuria (109 cases in 5.9 years) and mortality (385 deaths in 9.4 years). Univariate associations were tested by age-matched cases and controls and multivariate lipoprotein profiles were analysed using the self-organizing map (SOM).
TG and C levels in large VLDL were associated with incident albuminuria, TG and C in medium VLDL were associated with progression from microalbuminuria, and TG and C in all VLDL subclasses were associated with mortality. Large HDL-C was inversely associated with mortality. Three extreme phenotypes emerged from SOM analysis: (i) low C (<3% mortality), (ii) low TG/C ratio (6% mortality), and (iii) high TG/C ratio (40% mortality) in all subclasses.
TG–C imbalance is a general lipoprotein characteristic in individuals with T1DM and high vascular disease risk.