Serum Level of Triglycerides Is a Potent Risk Factor Comparable to LDL Cholesterol for Coronary Heart Disease in Japanese Patients with Type 2 Diabetes: Subanalysis of the Japan Diabetes Complications Study (JDCS)
Abstract
CONTEXT: Risk factors for cardiovascular complications in Japanese patients with diabetes have not been fully elucidated. OBJECTIVE: Our objective was to determine incidence of and risk factors for coronary heart disease (CHD) and stroke in Japanese diabetic patients. DESIGN AND SETTINGS: We conducted a prospective study at 59 hospitals throughout Japan. PATIENTS: Patients included 940 men and 831 women with type 2 diabetes (mean age, 58.2 yr) without a history of cardiovascular complications who were followed for a median of 7.86 yr. INTERVENTION: This was an observational study. MAIN OUTCOME MEASURES: Incidence of CHD and stroke was evaluated. RESULTS: Incidences of CHD and stroke per 1000 person-years were 9.59 and 7.45, respectively, whereas those of myocardial and brain infarctions were 3.84 and 6.29, respectively. Multivariate Cox analysis revealed that the serum log-transformed triglyceride level was a potent and independent predictor of CHD [hazard ratio (HR) = 1.54; 95% confidence interval (CI) = 1.22-1.94 per 1 sd increase), comparable to low-density lipoprotein (LDL) cholesterol (HR = 1.49; 95% CI = 1.25-1.78 per 1 sd increase). Triglycerides and LDL cholesterol linearly and continuously increased CHD risk, and subjects in the top third for both had markedly high risks of CHD, and their effects were possibly additive. However, serum triglycerides worked independently of blood pressure levels. Systolic blood pressure was the only significant predictor for stroke except for age (HR = 1.31; 95% CI = 1.04-1.65, per 1 sd increase). CONCLUSIONS: In Japanese patients with type 2 diabetes, the serum triglyceride level was a leading predictor of CHD, comparable to LDL cholesterol. Because the serum triglyceride level is not a leading predictor of CHD in diabetic subjects in Western countries, ethnic group-specific strategies for prevention of diabetic macroangiopathy may be indicated.
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To date, no correlation has been shown between dietary carbohydrate intake and risk of diabetes or diabetic control status.
“To date, no correlation has been shown between dietary carbohydrate intake and risk of diabetes or diabetic control status 13 , 14 .”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [13]
Real-time continuous glucose monitoring (rt-CGM) may be more effective than SMBG in improving glycemic control in pediatric and adult patients with type 1 diabetes and in adult patients with type 2 diabetes.
“A number of reports in the literature suggest that real‐time continuous glucose monitoring (rt‐CGM) may be more effective than self‐monitoring of blood glucose (SMBG) in improving glycemic control not only in pediatric and adult patients with type 1 diabetes but in adult patients with type 2 diabetes 13 , 14 , 15 .”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [13]
Ophthalmologic treatment such as retinal photocoagulation is useful for suppressing the progression of retinopathy.
“Ophthalmologic treatment such as retinal photocoagulation has been shown to be useful for suppressing the progression of retinopathy 13 , 14 (grade A: 95% agreement).”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [13]
Blood pressure control is effective in inhibiting the onset/progression of diabetic nephropathy.
“Blood pressure control is shown to be effective in inhibiting the onset/progression of diabetic nephropathy 11 , 12 , 13 (grade A: 100% agreement).”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [13]
Tight blood pressure control is effective in suppressing the risk of diabetic macroangiopathy.
“Tight blood pressure control has been shown to be effective in suppressing the risk of diabetic macroangiopathy 12 , 13 (grade A: 100% agreement).”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [13]
The use of statins reduces the risk of cardiovascular disease and mortality in patients with diabetes and dyslipidemia.
“The use of statins has been shown to reduce the risk of CVD and mortality in patients with diabetes and dyslipidemia 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 (grade A: 100% agreement).”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [13]
If appropriate perioperative support and safety are ensured, surgical therapy for obesity is effective in patients with type 2 diabetes and high-degree obesity who have difficulty losing weight.
“If appropriate perioperative support and safety are ensured, surgical therapy for obesity is shown to be effective in patients with type 2 diabetes and high‐degree obesity who have difficulty losing weight 11 , 12 , 13 , 14 (grade B: 90% agreement).”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [13]
On the basis of a composite analysis of secondary prevention studies, TNT and IDEA, and the post hoc analysis of the GREACE study, even with strict LDL-C-lowering therapy using statins, the risk for cardiovascular events is higher in patients who continue smoking than in lifelong nonsmokers or ex-smokers.
“On the basis of a composite analysis of secondary prevention studies, TNT and IDEA787), and the post hoc analysis of the GREACE study788), even with a strict LDL-C-lowering therapy using statins, the risk for cardiovascular events is higher in patients who continue smoking than in lifelong nonsmokers or the ex-smokers.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [788]
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References 39 · Cited by 201
- Authors
- Sone, H., Tanaka, S., Tanaka, S., Iimuro, S., Oida, K., Yamasaki, Y., Oikawa, S., Ishibashi, S., Katayama, S., Ohashi, Y., Akanuma, Y., Yamada, N., & for the Japan Diabetes Complications Study Group*
- Affiliations
- University of Tsukuba (JP)
- Kyoto University (JP)
- The University of Tokyo (JP)
- The University of Osaka (JP)
- Nippon Medical School (JP)
- Jichi Medical University (JP)
- Saitama Medical University (JP)
- The Institute of Medical Science, Asahi Life Foundation (JP)
- Corresponding author
- Sone, Hirohito
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2011-11
- Volume
- 96
- Issue
- 11
- Pages
- 3448-3456
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2120655733
- Cited by
- 201
- References
- 39
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 16 · 2023: 19 · 2022: 10 · 2021: 17 · 2020: 15 · 2019: 16 · 2018: 22 · 2017: 12 · 2016: 13 · 2015: 9 · 2014: 12 · 2013: 24 · 2012: 6
- FWCI
- 11.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Keio University
- Hokkaido University
- University of Tsukuba
- Jikei University School of Medicine
- Chiba University
- Japan Society for the Promotion of Science (20300227)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- serum triglycerides, LDL cholesterol, coronary artery disease, stroke, type 2 diabetes, cardiovascular risk factors, myocardial infarction, cerebral infarction, systolic blood pressure, diabetic macroangiopathy, Japanese patients
- MeSH terms
- Aged, Coronary Disease, Diabetes Mellitus, Type 2, Female, Humans, Japan, Cholesterol, LDL, Male, Middle Aged, Prospective Studies, Risk Factors, Triglycerides, Incidence, Stroke
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