Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Diabetologia
Published in: Diabetologia 5/2006

01-05-2006 | Article

Effect of age on the association of non-high-density-lipoprotein cholesterol and apolipoprotein B with cardiovascular mortality in a Mediterranean population with type 2 diabetes: the Casale Monferrato study

Authors: G. Bruno, F. Merletti, A. Biggeri, G. Bargero, S. Prina-Cerai, G. Pagano, P. Cavallo-Perin

Published in: Diabetologia | Issue 5/2006

Login to get access

Abstract

Aims/hypothesis

Measurement of plasma apolipoprotein (Apo) B may improve prediction of cardiovascular risk, as it provides a measure of the total number of atherogenic particles. The aim of this population-based study was to compare the association of non-HDL-cholesterol, ApoB and the ApoB:ApoA-I ratio with cardiovascular mortality in people with type 2 diabetes.

Subjects and methods

We assessed the association of lipids, lipoprotein lipids and apolipoproteins with 11-year mortality from cardiovascular disease in the population-based cohort of the Casale Monferrato Study (1,565 people with diabetes; median age 68.9 years), and determined the effect of age (≤70 and >70 years) on these relationships.

Results

On the basis of 341 deaths from cardiovascular disease in 10,809 person-years of observation, there was a decreasing trend in risk adjusted for multiple factors across quartiles of total cholesterol, and LDL- and non-HDL-cholesterol in people aged >70 years, but no trend in those aged ≤70 years. Age did not affect the protective effect of HDL-cholesterol. ApoB and ApoB:ApoA-I were associated with outcome in people in both age groups independently of non-HDL-cholesterol. After adjustment for multiple factors, including non-HDL-cholesterol, the hazard ratios for ApoB:ApoA-I in the upper vs lower quartile were 2.98 (95% CI 1.15–7.75; p for trend=0.009) for people aged ≤70 years and 1.94 (95% CI 1.20–3.13; p for trend=0.003) for those aged >70 years.

Conclusions/interpretation

In this cohort of Mediterranean subjects with diabetes, ApoB and the ApoB:ApoA-I ratio were associated with cardiovascular disease mortality independently of non-HDL-cholesterol. Our findings support the recommendation that ApoB and ApoA-I should be measured routinely in all people with diabetes, particularly in the elderly.
Literature
1.
Grundy SM, Cleeman JI, Merz CN et al (2004) Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol 44:720–732
2.
Dornbrook-Lavender KA, Pieper JA, Roth MT (2003) Primary prevention of coronary heart disease in the elderly. Ann Pharmacother 37:1654–1663
3.
Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD (2001) Cholesterol and all-cause mortality in elderly people from the Honolulu heart program. A cohort study. Lancet 358:351–355
4.
Fried L, Kronmal RA, Newman AB et al (1998) Risk factors for 5-year mortality in older adults. The Cardiovascular Health Study. JAMA 279:585–592
5.
Corti MC, Guralnik JM, Salive ME et al (1997) Clarifying the direct relation between total cholesterol levels and death from coronary heart disease in older persons. Ann Intern Med 126:753–760
6.
Krumholz HM, Seeman TE, Merrill SS et al (1994) Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. JAMA 272:1335–1340
7.
Dornbrook-Lavender KA, Pieper JA, Roth MT (2003) Primary prevention of coronary heart disease in the elderly. Ann Pharmacother 37:1654–1663
8.
Sniderman AD (2002) How, when, and why to use apolipoprotein B in clinical practice. Am J Cardiol 90(Suppl):48i–54i
9.
Sniderman AD, St-Pierre AC, Cantin B, Dagenais GR, Despres JP, Lamarche B (2003) Concordance/discordance between plasma apolipoprotein B levels and the cholesterol indexes of atherosclerotic risk. Am J Cardiol 91:1173–1177
10.
Sniderman AD, Furberg CD, Keech A et al (2003) Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatment. Lancet 361:777–780
11.
Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E (2001) High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet 358:2026–2033
12.
Yusuf S, Hawken S, Ounpuu S et al (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364:912–914
13.
Sniderman AD (2003) Non-HDL cholesterol versus apolipoprotein B in diabetic dyslipoproteinemia: alternatives and surrogates versus the real thing. Diabetes Care 26:2207–2208
14.
Wagner AM, Perez A, Zapico E, Ordonez-Llanos J (2003) Non-HDL cholesterol and apolipoprotein B in the dyslipidemic classification of type 2 diabetic patients. Diabetes Care 26:2048–2051
15.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2001) Executive summary of the Third Report of the National Cholesterol Education Program (NCEP), Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285:2486–2497
16.
Lehto S, Ronnemaa T, Haffner SM, Pyorala K, Kallio V, Laakso M (1997) Dyslipidemia and hyperglycemia predict coronary heart disease events in middle-aged patients with NIDDM. Diabetes 46:1354–1359
17.
Lu W, Resnick HE, Jablonski KA et al (2003) Non-HDL cholesterol as a predictor of cardiovascular disease in type 2 diabetes: the Strong Heart Study. Diabetes Care 26:16–23
18.
Schulze MB, Shai I, Manson JE et al (2004) Joint role of non-HDL cholesterol and glycated haemoglobin in predicting future coronary heart disease events among women with type 2 diabetes. Diabetologia 47:2129–2136
19.
Jiang R, Schulze MB, Li T et al (2004) Non-HDL cholesterol and apolipoprotein B predict cardiovascular disease events among men with type 2 diabetes. Diabetes Care 27:1991–1997
20.
Bruno G, Merletti F, Boffetta P et al (1999) Impact of glycaemic control, hypertension and insulin treatment on general and cause-specific mortality: an Italian population-based cohort of type II (non-insulin-dependent) diabetes mellitus. Diabetologia 42:297–301
21.
Brun E, Nelson RG, Bennett PH et al (2000) Verona Diabetes Study: diabetes duration and cause-specific mortality in the Verona Diabetes Study. Diabetes Care 23:1119–1123
22.
Bruno G, Cavallo-Perin P, Bargero G et al (1996) Prevalence and risk factors for micro- and macroalbuminuria in an Italian population-based cohort of non-insulin-dependent diabetic subjects. Diabetes Care 19:43–47
23.
Bruno G, Merletti F, Biggeri A et al (2005) Metabolic syndrome as predictor of all-causes and cardiovascular mortality in type 2 diabetes: the Casale Monferrato Study. Diabetes Care 27:2689–2694
24.
Bruno G, Merletti F, Biggeri A et al (2005) Fibrinogen and albumin excretion rate are major independent predictors of 11-year cardiovascular mortality in type 2 diabetes: the Casale Monferrato Study. Diabetologia 48:427–434
25.
Bruno G, LaPorte R, Merletti F, Biggeri A, McCarty D, Pagano G (1994) National diabetes programmes: application of capture-recapture to “count” diabetes? Diabetes Care 17:548–556
26.
Garancini MP (1996) L’epidemiologia del diabete non-insulino-dipendente e della ridotta tolleranza al glucosio. In: Vaccaro O, Bonora E, Bruno O, Garancini MP, Muntoni S, Società Italiana di Diabetologia Gruppo di Studio di Epidemiologia e Statistica (eds) Il Diabete in Italia. Kurtis, Milan pp 17–30
27.
Veglio M, Bruno G, Borra M et al (2002) Prevalence of increased QT interval duration and dispersion in type 2 diabetic patients and its relationship with coronary heart disease: a population-based cohort. J Intern Med 251:317–324
28.
Bruno G, Cavallo-Perin P, Bargero G et al (1999) Cardiovascular risk profile of type 2 diabetic patients cared for by general practitioners or by a diabetes clinic: a population-based study. J Clin Epidemiol 52:413–417
29.
Curb JD, Abbott RD, Rodriguez BL et al (2004) High density lipoprotein cholesterol and the risk of stroke in elderly men. The Honolulu Heart Program. Am J Epidemiol 160:150–157
30.
Corti MC, Guralnik JM, Salive ME et al (1995) HDL cholesterol predicts coronary heart disease mortality in older persons. JAMA 274:539–544
Metadata
Title
Effect of age on the association of non-high-density-lipoprotein cholesterol and apolipoprotein B with cardiovascular mortality in a Mediterranean population with type 2 diabetes: the Casale Monferrato study
Authors
G. Bruno
F. Merletti
A. Biggeri
G. Bargero
S. Prina-Cerai
G. Pagano
P. Cavallo-Perin
Publication date
01-05-2006
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 5/2006
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-006-0195-6

Other articles of this Issue 5/2006

Diabetologia 5/2006 Go to the issue

Letter

To: Holstein A, Stumvoll M (2005) Contraindications can damage your health—is metformin a case in point? Diabetologia 48:2454–2459

Article

Progression to type 1 diabetes in islet cell antibody-positive relatives in the European Nicotinamide Diabetes Intervention Trial: the role of additional immune, genetic and metabolic markers of risk

Article

Discordant gene expression in skeletal muscle and adipose tissue of patients with type 2 diabetes: effect of interleukin-6 infusion

Research Letter

Phenotypic heterogeneity between different mutations of MODY subtypes and within MODY pedigrees

Article

Activation of liver X receptors promotes lipid accumulation but does not alter insulin action in human skeletal muscle cells

Article

Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits