Lipids and apolipoproteins affect the risk of ST-elevation and non-ST-elevation myocardial infarctions differently in type 1 diabetes: a nationwide finnish cohort study
Authors' conclusion
We demonstrated that the risk profile between STEMI and NSTEMI differs regarding lipids and apolipoproteins, while insulin resistance was associated with increased risk of both MI subtypes.
Study context
- Population
- Individuals with T1D from the Finnish Diabetic Nephropathy Study
- Participants
- 4,215 individuals449 first-ever MIs
- Exposure
- Lipids, apolipoproteins and insulin resistance as risk factors for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI)
- Outcome
- Risk of all MI, STEMI and NSTEMI (first-ever MI verified from medical records and death certificates)
Methodological detailsobservational follow-up study, nationwide, multivariable Cox regression
- Observational follow-up study
- Nationwide
- Multivariable Cox regression
Main finding
As reported in the abstract
STEMI and NSTEMI risk by lipid, apolipoprotein and insulin-resistance variables (HR per 1 SD)
- STEMI: Apolipoprotein A-I (ApoA-I), HR per 1 SD 0.77 (95% CI 0.60-0.99); P = 0.043
- STEMI: HDL2 cholesterol (HDL2-C), HR 0.72 (0.55-0.95); P = 0.019
- STEMI: HDL-C/total cholesterol ratio, HR 0.76 (0.59-0.98); P = 0.035
- STEMI: no variables associated with increased risk
- NSTEMI: ApoB-100, HR 1.31 (1.15-1.50); P < 0.001
- NSTEMI: ApoB-100/ApoA-I ratio, HR 1.29 (1.18-1.41); P < 0.001
- NSTEMI: HDL-C/total cholesterol ratio, HR 0.71 (0.62-0.82); P < 0.001
- STEMI: higher estimated glucose disposal rate (lesser insulin resistance), HR 0.82 (0.73-0.92); P < 0.001
- NSTEMI: higher estimated glucose disposal rate, HR 0.92 (0.86-0.99); P = 0.024
- Multivariable Cox regression
Observational data: associations, not effects.
Further findings
All MI, stratified by microvascular complications
- Associations between selected lipid and apolipoprotein variables and MI risk appeared stronger among individuals without microvascular complications
Original publication
Lipids and apolipoproteins affect the risk of ST-elevation and non-ST-elevation myocardial infarctions differently in type 1 diabetes: a nationwide finnish cohort study. Cardiovasc Diabetol. Published 1 August 2026. doi:10.
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