A Shenzhen study suggests patients with type 2 diabetes may retain significant microvascular risk despite meeting recommended LDL cholesterol targets.
A new study published in the Journal of Global Health suggests that a commonly used measure of atherogenic risk may help identify people with type 2 diabetes who remain vulnerable to microvascular complications even after reaching recommended low-density lipoprotein cholesterol targets. The analysis, based on real-world community health records from Shenzhen, China, found that higher atherogenic index of plasma values were linked to a greater risk of diabetic kidney disease and diabetic peripheral neuropathy, but not diabetic retinopathy.
The findings matter because diabetes continues to expand at a global scale. The International Diabetes Federation says 589 million adults aged 20 to 79 are living with diabetes worldwide, and it projects that number will rise sharply in the coming decades. At the same time, European Society of Cardiology and European Atherosclerosis Society guidance still treats LDL cholesterol as a key treatment target, with a goal of below 2.6 mmol/L for moderate-risk patients. The Shenzhen researchers focused specifically on people who had already achieved that threshold, asking whether another lipid marker could reveal hidden residual risk.
The atherogenic index of plasma is calculated from the ratio of triglycerides to high-density lipoprotein cholesterol after a logarithmic transformation. In practice, it is intended to capture the balance between more harmful and more protective lipoproteins. The study followed 16,469 patients with type 2 diabetes, with a median age of 57, over a median 4.6 years. During that period, 1,056 people developed a microvascular complication. The highest third of atherogenic index of plasma values was associated with a 34% higher risk of any microvascular complication after full adjustment for demographic, lifestyle and clinical factors.
The signal was strongest for kidney disease. Compared with the lowest third, the highest third had a 62% higher risk of diabetic nephropathy in the fully adjusted model. For neuropathy, the equivalent increase was 39%. By contrast, the study did not find a statistically significant association between the index and diabetic retinopathy. The authors said the pattern may reflect organ-specific vulnerability, with kidney and nerve tissue appearing more sensitive to lipid-related injury than the retina in this population.
The results also appeared to hold up under several checks. The association remained after excluding participants with missing values, removing users of glucose- or lipid-lowering drugs, adding total cholesterol and LDL cholesterol to the model, and excluding early events in the first year of follow-up. The authors cautioned that the work was observational and cannot prove cause and effect. They also noted that complications were identified through inpatient records, which may have missed milder cases managed in outpatient care. Even so, they argued that the findings support a broader view of cardiovascular and metabolic risk in diabetes, one in which LDL cholesterol control alone may not tell the full story.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
