title: Atherogenic dyslipidemia and risk of silent coronary artery disease in asymptomatic patients with type 2 diabetes: a cross-sectional study.
abstract: To investigate whether atherogenic dyslipidemia, a dyslipidemic profile combining elevated triglycerides and low high-density lipoprotein (HDL) cholesterol, is predictive of risk of silent myocardial ischemia (SMI) or angiographic coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes.
  
  
  
  Cohort study in 1080 asymptomatic patients with type 2 diabetes with a normal resting electrocardiogram, at least one additional cardiovascular risk factor and low density lipoprotein (LDL) cholesterol <3.35 mmol/L. Patients initially underwent screening for SMI by stress myocardial scintigraphy. Patients with SMI underwent coronary angiography.
  
  
  
  Overall, 60 (5.5 %) patients had atherogenic dyslipidemia (triglycerides ≥2.26 mmol/L and HDL cholesterol ≤0.88 mmol/L). In multivariate analyses taking into account the parameters associated in univariate analyses with SMI and then CAD, atherogenic dyslipidemia was associated with SMI (odds ratio 1.8[1.0-3.3]), as were male gender (OR 2.1[1.5-2.9]), BMI (OR 0.97[0.94-0.997]), retinopathy (OR 1.4[1.1-1.9]), peripheral occlusive arterial disease (POAD: OR 2.5[1.6-3.8]) and mean blood pressure (OR 1.01[1.00-1.03]); atherogenic dyslipidemia was associated with CAD (OR 4.0[1.7-9.2]), as were male gender (OR 3.0[1.6-5.6]), BMI (OR 0.94[0.90-0.995]), retinopathy (OR 1.7[1.0-2.9], POAD (OR 4.0[2.1-7.4]) and mean blood pressure (OR 1.03[1.01-1.05]). In the subgroup of 584 patients with LDL cholesterol <2.6 mmol/L, atherogenic dyslipidemia was also associated with CAD (OR 3.6[1.5-9.0]).
  
  
  
  Atherogenic dyslipidemia was associated with an increased risk of SMI and silent CAD in patients with type 2 diabetes and LDL cholesterol levels <3.35 mmol/L. Specific management of atherogenic dyslipidemia might help reducing the high residual burden of cardiovascular disease.
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, Avenue du 14 Juillet, 93143, Bondy Cedex, France. paul.valensi@aphp.fr.
authors.forename: Paul
authors.initials: P
authors.lastname: Valensi
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CHRU Montpellier, 34295, Montpellier Cedex 5, France.|PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295, Montpellier Cedex 5, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Avignon
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CHRU Montpellier, 34295, Montpellier Cedex 5, France.|PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295, Montpellier Cedex 5, France.
authors.forename: Ariane
authors.initials: A
authors.lastname: Sultan
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, Avenue du 14 Juillet, 93143, Bondy Cedex, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chanu
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, Avenue du 14 Juillet, 93143, Bondy Cedex, France.
authors.forename: Minh Tuan
authors.initials: MT
authors.lastname: Nguyen
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, Avenue du 14 Juillet, 93143, Bondy Cedex, France.|Unité de Recherche Epidémiologique Nutritionnelle, UMR U1153 INSERM/U11125 INRA/CNAM/Université Paris 13, 93000, Bobigny, France.
authors.forename: Emmanuel
authors.identifier: 0000-0002-8785-3385
authors.initials: E
authors.lastname: Cosson
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy*; D001786:Blood Glucose / Q000032:analysis; D003324:Coronary Artery Disease / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004363:Drug Utilization; D050171:Dyslipidemias / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012737:Sex Factors
chemical_list: D001786:Blood Glucose
keywords: Atherogenic dyslipidemia; Diabetes; HDL-cholesterol; Residual cardiovascular risk; Silent myocardial ischemia; Triglycerides