Independent associations between low-density lipoprotein cholesterol and cancer among patients with type 2 diabetes mellitus
Independent associations between low-density lipoprotein cholesterol and cancer among patients with type 2 diabetes mellitus
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DOI：
10.1503/cmaj.071474
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发表时间：
2008-08-26
影响因子：
14.6
通讯作者：
Chan, Juliana C. N.
中科院分区：
文献类型：
--
作者：
Yang, Xilin;So, WingYee;Chan, Juliana C. N.
背景：低密度脂蛋白（LDL）胆固醇与癌症之间的风险关联仍然存在争议，并且在很大程度上未对未接受他汀类药物治疗的人群进行探索。方法：我们研究了2型糖尿病患者LDL胆固醇与癌症之间的风险关系，这些患者在入组时没有癌症，并且他汀类药物的使用是已知的。我们在分析中考虑了各种各样的非线性关系。结果：在中位随访期4.90年期间，6107例患者中有270例（4.4%）发生癌症。在3800名未接受他汀类药物治疗的患者中，LDL胆固醇与癌症之间的风险关联呈v形曲线。与LDL胆固醇≥2.80 mmol/L但小于3.80 mmol/L的患者相比，LDL胆固醇水平小于2.80 mmol/L（癌症风险比1.74,95%可信区间[CI] 1.20-2.52）和LDL胆固醇水平≥3.80 mmol/L（癌症风险比1.87,95% CI 1.29-2.71）的患者发生癌症、任何原因死亡或癌症或死亡的复合结局的风险更高。以3.8 mmol/L作为参考点，我们发现在不使用他汀类药物的患者中，LDL胆固醇每毫升/升绝对变化的癌症风险比为1.54 (95% CI 1.19-1.99)；整个样本（他汀类药物使用者和不使用他汀类药物的人）的风险比降至1.24（1.01-1.53）。在调整协变量并排除随访时间少于2.5年的患者后，这些关联仍然存在。解释：在2型糖尿病患者中，低密度脂蛋白胆固醇与癌症之间呈v型关系，即低水平和高水平的低密度脂蛋白胆固醇都与癌症风险升高相关。
Background: The risk association between low-density lipoprotein (LDL) cholesterol and cancer remains controversial and largely unexplored for people not receiving statin therapy.Methods: We examined the risk association between LDL cholesterol and cancer among patients with type 2 diabetes mellitus who were free of cancer at enrolment and whose statin use was known. We considered a variety of nonlinear relationships in our analysis.Results: During a median follow-up period of 4.90 years, cancer developed in 270 (4.4%) of 6107 patients. Among the 3800 patients who did not receive statin therapy, the risk association between LDL cholesterol and cancer was represented by a V-shaped curve. Compared with patients whose LDL cholesterol was at least 2.80 mmol/L but less than 3.80 mmol/L, the risk of cancer, death from any cause or the composite outcome of cancer or death was greater among those with an LDL cholesterol level of less than 2.80 mmol/L (hazard ratio for cancer 1.74, 95% confidence interval [CI] 1.20-2.52) and those with an LDL cholesterol level of 3.80 mmol/L or greater (hazard ratio for cancer 1.87, 95% CI 1.29-2.71). Using 3.8 mmol/L as a reference point, we found that the hazard ratio for cancer for every millimole per litre absolute change in LDL cholesterol was 1.54 (95% CI 1.19-1.99) among patients not using statins; the hazard ratio was reduced to 1.24 (1.01-1.53) for the entire sample (statin users and those not using statins). These associations persisted after adjustment for covariates and exclusion of patients with less than 2.5 years of follow-up.Interpretation: Among patients with type 2 diabetes, the association between LDL cholesterol and cancer was V-shaped, whereby both low and high levels of LDL cholesterol were associated with elevated risk of cancer.