Layered Effects of LDL ‐C Burden and Variability on Cardiovascular Events and Mortality in Type 2 Diabetes: A Nationwide Cohort Study
Main finding · Composite CVDResult — go to the resultAdjusted hazard ratio 1.49 CI 1.39–1.60Authors' conclusion
In T2DM, LDL-C burden and variability jointly identified patients at greater risk, especially for MI and cardiovascular mortality.
Study context
- Population
- Korean adults with T2D who underwent National Health Insurance Service health screening in 2015–2016; outcomes through 2022
- Participants
- 258,183 adults
- Exposure
- Low-density lipoprotein cholesterol (LDL-C) burden and visit-to-visit variability
- Outcome
- Composite incident CVD
- Follow-up
- Median 7.14 years
Methodological detailsCox models
- Cox models
Main finding
Composite CVD
Adjusted hazard ratio
1.49
CI 1.39–1.60
By group
4 episodesvs 0 episodes
aHR 1.49 (CI 1.39–1.60)
As reported in the abstract
- Composite cardiovascular disease (CVD) events
- 10 886
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | |
|---|---|---|
| Composite CVD by variability, overallQ4vs Q1-Q3High variability modestly increased CVD risk | 1.09 (1.05–1.14) | |
| 0.512Hazard ratio (log scale) |
Per 1000 person-years
| Outcome | Q4 | Q1-Q3 |
|---|---|---|
| Composite CVD incidence by variability (subgroup: 4 episodes) | 7.49 | 6.47 |
Myocardial infarction (MI)
- Association of LDL-C burden stronger for MI than for stroke; MI HR
- 1.66 (1.52-1.82)
Ischemic stroke
- Association of LDL-C burden with stroke; HR
- 1.32 (1.20-1.46)
CV mortality
- CV mortality risk elevated only at the highest burden; HR
- 1.48 (1.21-1.81) (95% CI)
CV mortality, highest burden with concurrent Q4 variability
- Risk increased further with concurrent Q4 variability; HR
- 2.48 (1.53-4.00) (95% CI)
All-cause mortality
- Inversely associated overall; pattern modified by high variability, particularly in younger adults or longer-duration diabetes subgroups
Original publication
Layered Effects of LDL ‐C Burden and Variability on Cardiovascular Events and Mortality in Type 2 Diabetes: A Nationwide Cohort Study. Diabetes Obes Metab. Published 17 September 2026. doi:10.
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