In diabetic patients, a study breaks the mold that low LDL-C as well as high low density lipoprotein cholesterol (LDL-C) are associated with an increased risk of sudden cardiac arrest (SCA). announced and noticed.
On the 20th, in the international academic journal ‘Cardiovascular Diabetology’, a research team led by professors Kim Yun-ki and Jung Ju-hee of the Department of Cardiology at Korea University Anam Hospital published ‘The association between acute cardiac arrest and LDL-C in diabetic patients’ (original title: Association between low-density lipoprotein cholesterol and sudden cardiac arrest in people with diabetes mellitus)’ paper was published.
Acute cardiac arrest is a sudden and unexpected cardiac arrest that can cause irreversible sequelae despite prompt and successful resuscitation. For this reason, discussions on the primary prevention of sudden cardiac arrest through the identification and stratification of risk factors have been ongoing for the past decades, but still remain unresolved to this day.
The research team focused on the fact that dyslipidemia is an established risk factor for cardiovascular disease and is more prominent in the diabetic population. To investigate the association between the LDL-C level and the risk of sudden cardiac arrest by analyzing sudden cardiac arrest events in a group of patients.
A total of 2,602,577 diabetic patients were included in the analysis, and 26,341 cases of acute cardiac arrest were identified during a median follow-up of 6.86 years.
The researchers divided diabetic patients into eight groups according to their LDL-C levels and analyzed them. was found to decrease in a linear fashion as
However, following adjusting for various confounding factors, the risk of sudden cardiac arrest showed a U-shaped association according to the LDL-C level. The second highest risk of sudden cardiac arrest in the lowest LDL-C group (less than 70 mg/dL) following the highest LDL-C group (160 mg/dL or greater) (Figure).
Additionally, in the subgroup analysis, the U-shaped association between sudden cardiac arrest risk and LDL-C was more pronounced in males, non-obese, and non-statin users.
“In general, LDL-C levels show a positive, linear correlation with cardiovascular events,” the researchers wrote in the paper. “The most recent study showed that lowering LDL-C levels to 40 mg/dL further reduced major cardiovascular events. In addition, long-term lowering of LDL-C is associated with a reduced risk of atherosclerotic cardiovascular disease, so in actual clinical practice, ‘the lower, the better’ is a powerful lipid including statins, ezetimibe, and PCSK9 inhibitors. It has become the paradigm of descending strategy,” he explained.
However, in diabetic patients, the association between sudden cardiac arrest and LDL-C levels was not positively linear, but U-shaped (the risk of sudden cardiac arrest was higher in the highest and lowest LDL-C groups than in other groups).
“In this study, the traditional effect of LDL-C on cardiovascular mortality was reversed in terms of risk of sudden cardiac arrest,” the researchers said. The association was more pronounced in the statin-naive subgroup and the non-obese subgroup.”
“In diabetic patients, not only high LDL-C but also low LDL-C are associated with an increased risk of sudden cardiac arrest.” It can be a surrogate marker for the high-risk group of sudden cardiac arrest.”
However, the researchers added that the results of the study should be interpreted and applied with caution in a clinical setting.
Although the study found an inverse increase in the risk of sudden cardiac arrest in the low LDL-C group, it does not mean that low LDL-C directly causes sudden cardiac arrest.
“On the other hand, prolonged exposure to excessive LDL-C exacerbates the atherosclerotic plaque burden, leading to significant atherosclerotic cardiovascular disease and related side effects,” the researchers said. You shouldn’t change your current treatment,” he stressed.
“However, clinicians must accept that the risk of sudden cardiac arrest is increased in the low-LDL-C group,” the researchers said. We need to reconsider whether we know it or not,” he advised.
“In order to apply these results to clinical settings and preventive measures for sudden cardiac arrest, it is necessary to further investigate the mechanism of the inverse relationship between LDL-C and sudden cardiac arrest.”
