ArticleFrontiers in endocrinology2025
The interaction between blood lipids and ASCVD increases the risk of DKD: a nonlinear relationship transforms into a linear relationship, a cross-sectional study.
Article in Frontiers in endocrinology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Atherosclerotic cardiovascular disease (ASCVD) and diabetic kidney disease (DKD) are interconnected vascular complications in diabetes, with dyslipidemia playing a key role. The modifying effect of ASCVD on the lipid-DKD relationship in diabetic patients without lipid-lowering treatment remains unclear. Methods: This retrospective study included 26,476 type 2 diabetic patients without lipid-lowering therapy. Associations between lipids (LDL-C, TC, TG, HDL-C) and DKD risk were analyzed using regression and restricted cubic spline (RCS) curves analysis. Both multiplicative and additive interactions between lipids and ASCVD were assessed. Results: HDL-C showed a significant linear association with DKD. RCS analyses revealed distinct patterns based on ASCVD status: significant threshold effects for LDL-C (2.68 mmol/L), TC (4.29 mmol/L), TG (2.48 mmol/L), and HDL-C (1.64 mmol/L) on DKD risk were observed only in diabetic patients without ASCVD. No significant nonlinear threshold effects were found for LDL-C, TC, HDL-C on DKD risk in diabetic patients with ASCVD. LDL-C and TC showed continuous increases in DKD risk without a discernible safe threshold in diabetic patients with ASCVD. Crucially, a strong synergistic interaction existed between ASCVD and both TC (RERI=7.46, AP=0.25, SI=1.34) and LDL-C (RERI=9.91, AP=0.27, SI=1.38), significantly amplifying their adverse effects on renal injury. Conclusion: ASCVD amplifies the detrimental renal effects of TC and LDL-C and eliminates protective lipid thresholds in diabetic patients. Consequently, lipid management in diabetic patients should be individualized: strict control of TC and LDL-C is prioritized for those with ASCVD, while consideration of lipid threshold effects is key for those without ASCVD.
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