›› 2017, Vol. 37 ›› Issue (6): 744-.doi: 10.3969/j.issn.1674-8115.2017.06.006

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Study on the predictive effect of baseline lipid profiles on recurrent cardiovascular events after antidiabetic drugs intervention

ZHAO Dan-dan1, GU Yan-yun1, WANG Ji-qiu1, HU Chun-xiu2, HONG Jie1, ZHANG Yi-fei1, the SPREAD-DIMCAD study group1   

  1. 1. Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 2. Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian 116023, China
  • Online:2017-06-28 Published:2017-07-05
  • Supported by:

    National Natural Science Foundation of China, 81471074,81670797; Shanghai Foundation for Development of Science and Technology, 14411964700; Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20161411; National Key R&D Plan, 2016YFC0901200; “Dawn” Program of Shanghai Education Commission, 14SG17

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Abstract:

 Objective · To explore the relationship between baseline lipid profiles and long-term cardiovascular outcomes after intervention with hypoglycemic drugs metformin and glipizide and to detect lipid components that can predict the long-term cardiovascular effect of metformin and glipizide.  Methods · Liquid chromatography–quadrupole time of flight–mass spectrometry (LC-QTOF/MS) was used to measure 119 lipid components in baseline serum for 116 patients with type 2 diabetes (T2DM) and atherosclerotic heart disease (CHD) who were treated with glipizide (56 cases, the glipizide group) or metformin (60 cases, the metformin group). Cardiovascular complex end points (including cardiovascular death, all-cause death, nonfatal myocardial infarction, nonfatal stroke, and arterial revascularization) of all patients were followed up. The relationship between lipid components and cardiovascular  complex end points was analyzed with Logistic regression analysis. The category-free net reclassification index (cfNRI) and the integrated discrimination improvement (IDI) were used to evaluate whether lipid components are helpful for predicting the recurrent cardiovascular events.  Results · The differences in baseline drug distribution, clinical characteristics, and biochemical indexes between two groups were not statistically significant, except for diuretics use, serum PC (O-34:2) level, and SM (d18:0-24:0) level. Logistic regression analysis showed that baseline ChE (20:4) was a protective factor for recurrent cardiovascular events in the glipizide group (OR=0.87, P=0.039). ChE (20:4) significantly increased the cfNRI and IDI of cardiovascular  complex end points by 69% and 0.07, respectively (P=0.011, P=0.028). Baseline SM (d18:1-22:0) was a risk factor for recurrent cardiovascular events in the metformin group and all participants (OR=1.65, P=0.039; OR=1.64, P=0.014). SM (d18:1-22:0) significantly increased the cfNRI of cardiovascular  complex end points in the metformin group and all participants by 74% and 55%, respectively (P=0.012, P=0.005).  Conclusion · Of 119 lipid components measured with LC-QTOF/ MS, baseline ChE (20:4) is a protective factor and SM (d18:1-22:0) is a risk factor for cardiovascular  complex end points in with T2DM and CHD patients after long-term treatment with metformin and glipizide. Both lipid components are helpful for improving the prediction of recurrent cardiovascular events.

Key words: type 2 diabetes, cardiovascular disease, lipid profiles, metformin, glipizide