title: Association of lipids with incident heart failure among adults with and without diabetes mellitus: Multiethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Dyslipidemia is a known risk factor for coronary disease, but its role in heart failure (HF) development is less well-defined.
  
  
  RESULTS
  We included 5688 participants, aged 45 to 84 years, without clinical cardiovascular disease, and not receiving lipid-lowering medications at baseline, from the Multiethnic Study of Atherosclerosis. Cox-proportional hazards models were used to evaluate associations of triglyceride, total cholesterol/high-density lipoprotein-cholesterol (HDL-C) ratio, HDL-C, and non HDL-C with incident HF. We investigated for effect-modification by diabetes mellitus status and sex. During a median follow-up of 8.5 years, there were 152 incident HF cases. There were no interactions by sex. We observed significant interactions between triglyceride and diabetes mellitus (P(interaction)<0.05). We stratified our analyses by diabetes mellitus status. In participants with diabetes, the hazard ratios were 2.03 (0.97-4.27) and 1.68 (1.18-2.38) for high triglyceride and log of triglyceride, respectively, after adjusting for confounders, comorbidities, and diabetes mellitus severity/treatment. The association of high triglyceride with incident HF was attenuated by interim myocardial infarction. The hazard ratios were greatest in participants with diabetes who also had high triglyceride, low HDL-C, or high total cholesterol/HDL-C ratio (3.59 [2.03-6.33], 3.62 [2.06-6.36], and 3.54 [1.87-6.70], respectively). Lipid measures were not associated with incident HF in individuals without diabetes.
  
  
  CONCLUSIONS
  The risk of incident HF is greater in individuals with diabetes mellitus who also have high triglyceride, low HDL-C, or high total cholesterol/HDL-C ratio. The association of high triglyceride with incident HF is partly mediated by myocardial infarction.
authors.affiliation: Department of Medicine, University of Southern California, Los Angeles, CA 90089, USA. ebong@usc.edu
authors.forename: Imo A
authors.initials: IA
authors.lastname: Ebong
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Rodriguez
authors.forename: Haiying
authors.initials: H
authors.lastname: Chen
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Sibley
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D008076:Cholesterol, HDL / Q000097:blood; D003925:Diabetic Angiopathies / Q000097:blood* / Q000453:epidemiology / Q000208:ethnology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control; D006630:Hispanic or Latino; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D044465:White People
chemical_list: D008076:Cholesterol, HDL; D008055:Lipids; D014280:Triglycerides
keywords: diabetes mellitus; heart failure; lipids