title: Different lipid variables predict incident coronary artery disease in patients with type 1 diabetes with or without diabetic nephropathy: the FinnDiane study.
abstract: OBJECTIVE
  To study the ability of lipid variables to predict incident coronary artery disease (CAD) events in patients with type 1 diabetes at different stages of nephropathy.
  
  
  METHODS
  Patients (n = 3,520) with type 1 diabetes and available lipid profiles participating in the Finnish Diabetic Nephropathy Study (FinnDiane) were included in the study. During a follow-up period of 10.2 years (8.6-12.0), 310 patients suffered an incident CAD event.
  
  
  RESULTS
  Apolipoprotein B (ApoB)/ApoA-I ratio was the strongest predictor of CAD in normoalbuminuric patients (hazard ratio 1.43 [95% CI 1.17-1.76] per one SD increase), and ApoB was the strongest in macroalbuminuric patients (1.47 [1.19-1.81]). Similar results were seen when patients were stratified by sex or glycemic control. LDL cholesterol was a poor predictor of CAD in women, normoalbuminuric patients, and patients with HbA1c below the median (8.3%, 67 mmol/L). The current recommended triglyceride cutoff of 1.7 mmol/L failed to predict CAD in normoalbuminuric patients, whereas the cohort median 0.94 mmol/L predicted incident CAD events.
  
  
  CONCLUSIONS
  In patients with type 1 diabetes, the predictive ability of the lipid variables differed substantially depending on the patient's sex, renal status, and glycemic control. In normoalbuminuric patients, the ratios of atherogenic and antiatherogenic lipoproteins and lipids were the strongest predictors of an incident CAD event, whereas in macroalbuminuric patients, no added benefit was gained from the ratios. Current treatment recommendations may need to be revised to capture residual CAD risk in patients with type 1 diabetes.
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
authors.forename: Nina
authors.initials: N
authors.lastname: Tolonen
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
authors.forename: Carol
authors.initials: C
authors.lastname: Forsblom
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandDepartment of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CASouth Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: Ville-Petteri
authors.initials: VP
authors.lastname: Mäkinen
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, FinlandDiabetes Prevention Unit, Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Valma
authors.initials: V
authors.lastname: Harjutsalo
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gordin
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
authors.forename: Maija
authors.initials: M
authors.lastname: Feodoroff
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, FinlandAalto University, Espoo, Finland.
authors.forename: Niina
authors.initials: N
authors.lastname: Sandholm
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
authors.forename: Lena M
authors.initials: LM
authors.lastname: Thorn
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
authors.forename: Johan
authors.initials: J
authors.lastname: Wadén
authors.affiliation: Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Marja-Riitta
authors.initials: MR
authors.lastname: Taskinen
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandResearch Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, FinlandBaker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia per-henrik.groop@helsinki.fi.
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Groop
mesh_terms: D000328:Adult; D016632:Apolipoprotein A-I / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008055:Lipids / Q000097:blood*; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
chemical_list: D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D001786:Blood Glucose; D008078:Cholesterol, LDL; D008055:Lipids; D008074:Lipoproteins; D014280:Triglycerides