Lower extremity arterial atherosclerosis is a significant contributor to adverse outcomes in patients with diabetes. Early-onset type 2 diabetes mellitus (T2DM) is associated with a more severe disease phenotype, necessitating close monitoring. However, the optimal lipid biomarker for assessing the likelihood of lower extremity artery atherosclerosis in this population remains unclear. We aimed to identify and quantify the association between lipid indices and the likelihood of atherosclerosis in patients with early-onset T2DM. A total of 374 patients with early-onset T2DM were included in this study. The Boruta algorithm was used to identify key factors associated with lower extremity artery atherosclerosis. Logistic regression models, restricted cubic splines, and subgroup analyses were employed to examine the association between lipid indices and lower extremity artery atherosclerosis. Receiver operating characteristic (ROC) analysis was used to evaluate the discriminative power of the lipid indices and determine their optimal cut-off values. The Boruta algorithm indicated that blood lipids were critical factors associated with lower extremity artery atherosclerosis in patients with early-onset T2DM. Low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and the LDL-C/HDL-C ratio (low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio) levels were significantly associated with the likelihood of lower extremity artery atherosclerosis before and after adjusting for confounders, and the relationships were linear. After full adjustment, each 1-SD increase in LDL-C, TC, and the LDL-C/HDL-C ratio was associated with a 74.6%, 66.9%, and 43.8% higher likelihood of lower extremity arterial atherosclerosis, respectively. Systemic inflammation did not significantly modify the relationships between LDL-C, TC, the LDL-C/HDL-C ratio, and the presence of lower extremity atherosclerosis in patients with early-onset diabetes (all P-interaction > 0.05). In the ROC analysis, the area under the curve (AUC) values for LDL-C, TC, and the LDL-C/HDL-C ratio were 0.620 (95% CI 0.550–0.690), 0.617 (95% CI 0.548–0.687), and 0.600 (95% CI 0.527–0.674), respectively, with no statistically significant differences among them. TG (triglyceride), HDL-C, the TG/HDL-C ratio, and the TC/HDL-C ratio were not associated with lower-extremity artery atherosclerosis in logistic regression and/or ROC analyses. In patients with early-onset T2DM, LDL-C, TC, and the LDL-C/HDL-C ratio showed stronger associations with lower extremity artery atherosclerosis compared to other lipid biomarkers. These atherogenic lipid indices may serve as the most discriminative indicators of lower extremity atherosclerosis in this high-risk population.
Yu et al. (Mon,) studied this question.