Elevation of Both apoB and nonHDL-C Imply Greater Atherosclerosis Risk in Type 1 Diabetes

Petter Bjornstad, MDFellow in Pediatric Diabetes & Endocrinology Children's Hospital Colorado & Barbara Davis Center for Childhood Diabetes Aurora, CO 80045MedicalResearch.com Interview with:
Petter Bjornstad, MD
Fellow in Pediatric Diabetes & Endocrinology
Children’s Hospital Colorado & Barbara Davis Center for Childhood Diabetes
Aurora, CO 80045


MedicalResearch: What is the background for this study?

Dr. Bjornstad: Apolipoprotein B (apoB) and non-high density lipoprotein-cholesterol (nonHDL-C) have been proposed to be superior indicators of cardiovascular (CV) risk than total cholesterol and/or low density lipoprotein-cholesterol (LDL-C). Some authors argue that while nonHDL-C and apoB correlate, they are not necessarily interchangeable, and may in fact provide unique information about cardiovascular risk. However, there are insufficient data on the concordance between apoB and nonHDL-C in adults with type 1 diabetes mellitus (DM) across a wide range of risk factors for cardiovascular disease.

MedicalResearch: What are the main findings?

Dr. Bjornstad: Adults with type 1 diabetes and elevated apoB (≥90mg/dL) and nonHDL-C (≥130mg/dL) had greater odds of coronary artery calcification progression compared to adults with type 1 diabetes and normal apoB and nonHDL-C (OR: 1.90, 95% CI 1.15-3.15), and compared to adults with type 1 diabetes with elevated apoB alone (OR: 2.86, 95% CI 1.43-5.74) adjusting for age, sex, duration, HbA1c and statins. We also obtained similar results with elevated apoB and nonHDL-C defined as ≥ the cohort means. Accordingly, we concluded that elevated apoB and nonHDL-C carry a greater risk of atherosclerosis than elevated apoB in the absence of elevated nonHDL-C in adults with type 1 diabetes. 

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Bjornstad: Although nonHDL-C and apoB correlate and elevated categories of each measure are concordant, our data show that a significant proportion of adults with type 1 diabetes had elevated apoB in the absence of elevated nonHDL-C, a lipid profile that was associated with lower risk of atherosclerosis than elevated apoB and elevated nonHDL-C. In other words, our data suggest that apoB and nonHDL-C should be viewed as complementary rather than competitive indices of CVD risk in type 1 diabetes.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Bjornstad: Our 6-year follow-up may have been insufficient to fully examine progression of coronary artery calcification in a cohort of relatively young adults with type 1 diabetes and fairly favorable lipid profiles. For that reason, further research should examine the longitudinal relationships of apoB and nonHDL-C with atherosclerosis and CV events over a longer time in adults with type 1 diabetes.

Citation:

Relation of Combined Non-High Density Lipoprotein-Cholesterol and Apolipoprotein B with Atherosclerosis in Adults with Type 1 Diabetes Mellitus

Bjornstad, Petter et al. American Journal of Cardiology

Petter Bjornstad, MD (2015). Elevation of Both apoB and nonHDL-C Imply Greater Atherosclerosis Risk in Type 1 Diabetes