期刊
JOURNAL OF INTERNAL MEDICINE
卷 291, 期 3, 页码 338-349出版社
WILEY
DOI: 10.1111/joim.13412
关键词
apolipoprotein C-III; cardiovascular disease; diabetes mellitus; diabetic nephropathy; dyslipidemia; mortality; type 1
资金
- Folkhalsan Research Foundation
- Wilhelm and Else Stockmann Foundation
- Medical Society of Finland
- Finnish Diabetes Research Foundation
- Liv och Halsa Society
- Finnish Foundation for Cardiovascular Research
- Waldemar von Frenckell Foundation
- Finnish Kidney Foundation
- Dorothea Olivia, Karl Walter, and Jarl Walter Perklen Foundation
- Academy of Finland [316664, 299200]
- Signe and Ane Gyllenberg Foundation
- Sigrid Juselius Foundation
- Novo Nordisk Foundation (NNF) [OC0013659]
- Paivikki and Sakari Sohlberg Foundation
- EVO governmental grant [TYH2018207]
The study found that apoC-III can independently predict the progression of DKD in patients with type 1 diabetes, and is associated with cardiovascular events and mortality, especially in individuals with albuminuria.
Objectives We studied apolipoprotein C-III (apoC-III) in relation to diabetic kidney disease (DKD), cardiovascular outcomes, and mortality in type 1 diabetes. Methods The cohort comprised 3966 participants from the prospective observational Finnish Diabetic Nephropathy Study. Progression of DKD was determined from medical records. A major adverse cardiac event (MACE) was defined as acute myocardial infarction, coronary revascularization, stroke, or cardiovascular mortality through 2017. Cardiovascular and mortality data were retrieved from national registries. Results ApoC-III predicted DKD progression independent of sex, diabetes duration, blood pressure, HbA(1c), smoking, LDL-cholesterol, lipid-lowering medication, DKD category, and remnant cholesterol (hazard ratio [HR] 1.43 [95% confidence interval 1.05-1.94], p = 0.02). ApoC-III also predicted the MACE in a multivariable regression analysis; however, it was not independent of remnant cholesterol (HR 1.05 [0.81-1.36, p = 0.71] with remnant cholesterol; 1.30 [1.03-1.64, p = 0.03] without). DKD-specific analyses revealed that the association was driven by individuals with albuminuria, as no link between apoC-III and the outcome was observed in the normal albumin excretion or kidney failure categories. The same was observed for mortality: Individuals with albuminuria had an adjusted HR of 1.49 (1.03-2.16, p = 0.03) for premature death, while no association was found in the other groups. The highest apoC-III quartile displayed a markedly higher risk of MACE and death than the lower quartiles; however, this nonlinear relationship flattened after adjustment. Conclusions The impact of apoC-III on MACE risk and mortality is restricted to those with albuminuria among individuals with type 1 diabetes. This study also revealed that apoC-III predicts DKD progression, independent of the initial DKD category.
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