Scholarlink

Background <p>Non-ST-elevation myocardial infarction (NSTEMI) has become the main myocardial infarction subtype in type 1 diabetes compared to ST-elevation myocardial infarction (STEMI), accounting for nearly 80% of myocardial infarction-related hospitalizations. Yet, prior studies in type 1 diabetes have assessed myocardial infarctions as a single entity, potentially overlooking clinically relevant heterogeneity between subtypes in risk assessment. We aimed to study the role of lipids, apolipoproteins, insulin resistance, and the metabolic syndrome in risk stratification of all myocardial infarctions, STEMI and NSTEMI in individuals with type 1 diabetes stratified by the presence of microvascular complications.</p> Methods <p>The current study is an observational follow-up study of 4215 individuals from the Finnish Diabetic Nephropathy Study. We verified 449 first-ever myocardial infarctions from medical records and death certificates and further categorized them into either STEMI or NSTEMI. Multivariable Cox regression models were used to assess the effect of a comprehensive lipid and apolipoprotein panel and insulin resistance on the risk of all myocardial infarctions, STEMI, and NSTEMI. Risk estimates for all myocardial infarctions were additionally stratified based on the presence of microvascular complications.</p> Results <p>For STEMI, apolipoprotein A-I (ApoA-I) (hazard ratio per 1 standard deviation 0.77 [95% confidence interval 0.60–0.99]; <i>P</i> = 0.043), HDL2 cholesterol (HDL2-C) (0.72 [0.55–0.95]; <i>P</i> = 0.019), and HDL-C/total cholesterol ratio (0.76 [0.59–0.98]; <i>P</i> = 0.035) were associated with reduced risk, while no variables were associated with increased risk. Regarding NSTEMI, apolipoprotein B-100 (ApoB-100) (1.31 [1.15–1.50]; <i>P</i> &lt; 0.001) and ApoB-100 to apolipoprotein A-I (ApoA-I) ratio (1.29 [1.18–1.41]; <i>P</i> &lt; 0.001) showed the strongest association with an increased risk, while the HDL-C/total cholesterol ratio was associated with reduced risk (0.71 [0.62–0.82]; <i>P</i> &lt; 0.001). In stratified analyses, associations between selected lipid and apolipoprotein variables and myocardial infarction risk appeared stronger among individuals without microvascular complications. Higher estimated glucose disposal rate, indicating lesser insulin resistance, was associated with reduced risk of both STEMI (0.82 [0.73–0.92]; <i>P</i> &lt; 0.001) and NSTEMI (0.92 [0.86–0.99]; <i>P</i> = 0.024).</p> Conclusions <p>We demonstrated that the risk profile between STEMI and NSTEMI differs regarding lipids and apolipoproteins, while insulin resistance was associated with increased risk of both MI subtypes.</p> Graphical Abstract <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Lipids and apolipoproteins affect the risk of ST-elevation and non-ST-elevation myocardial infarctions differently in type 1 diabetes: a nationwide finnish cohort study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年8月1日

查看全文
  • Patrik Smidtslund,
  • Fanny Jansson Sigfrids,
  • Valma Harjutsalo,
  • Ville Thorn,
  • Marja-Riitta Taskinen,
  • Per-Henrik Groop,
  • Lena M Thorn

摘要

Background

Non-ST-elevation myocardial infarction (NSTEMI) has become the main myocardial infarction subtype in type 1 diabetes compared to ST-elevation myocardial infarction (STEMI), accounting for nearly 80% of myocardial infarction-related hospitalizations. Yet, prior studies in type 1 diabetes have assessed myocardial infarctions as a single entity, potentially overlooking clinically relevant heterogeneity between subtypes in risk assessment. We aimed to study the role of lipids, apolipoproteins, insulin resistance, and the metabolic syndrome in risk stratification of all myocardial infarctions, STEMI and NSTEMI in individuals with type 1 diabetes stratified by the presence of microvascular complications.

Methods

The current study is an observational follow-up study of 4215 individuals from the Finnish Diabetic Nephropathy Study. We verified 449 first-ever myocardial infarctions from medical records and death certificates and further categorized them into either STEMI or NSTEMI. Multivariable Cox regression models were used to assess the effect of a comprehensive lipid and apolipoprotein panel and insulin resistance on the risk of all myocardial infarctions, STEMI, and NSTEMI. Risk estimates for all myocardial infarctions were additionally stratified based on the presence of microvascular complications.

Results

For STEMI, apolipoprotein A-I (ApoA-I) (hazard ratio per 1 standard deviation 0.77 [95% confidence interval 0.60–0.99]; P = 0.043), HDL2 cholesterol (HDL2-C) (0.72 [0.55–0.95]; P = 0.019), and HDL-C/total cholesterol ratio (0.76 [0.59–0.98]; P = 0.035) were associated with reduced risk, while no variables were associated with increased risk. Regarding NSTEMI, apolipoprotein B-100 (ApoB-100) (1.31 [1.15–1.50]; P < 0.001) and ApoB-100 to apolipoprotein A-I (ApoA-I) ratio (1.29 [1.18–1.41]; P < 0.001) showed the strongest association with an increased risk, while the HDL-C/total cholesterol ratio was associated with reduced risk (0.71 [0.62–0.82]; P < 0.001). In stratified analyses, associations between selected lipid and apolipoprotein variables and myocardial infarction risk appeared stronger among individuals without microvascular complications. Higher estimated glucose disposal rate, indicating lesser insulin resistance, was associated with reduced risk of both STEMI (0.82 [0.73–0.92]; P < 0.001) and NSTEMI (0.92 [0.86–0.99]; P = 0.024).

Conclusions

We demonstrated that the risk profile between STEMI and NSTEMI differs regarding lipids and apolipoproteins, while insulin resistance was associated with increased risk of both MI subtypes.

Graphical Abstract