Joint Control of Inflammation, Cholesterol, and Lipoprotein(a) With Incident Cardiovascular Events in People With Type 2 Diabetes

OBJECTIVE We aimed to investigate the joint associations of high-sensitivity C-reactive protein (hsCRP), LDL cholesterol (LDL-C), and lipoprotein(a) [Lp(a)] with cardiovascular disease (CVD) among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS This prospective cohort study identified patients with type 2 diabetes from the UK Biobank. Baseline hsCRP, LDL-C, and Lp(a) were dichotomized according to guideline-recommended target levels. Patients were followed for incident atherosclerotic cardiovascular disease (ASCVD), total CVD (ASCVD plus heart failure), death, or study end. Competing risk models adjusted for important covariates were used. RESULTS There were 29,658 patients with type 2 diabetes who were followed for a median of 15 years. Those with all three biomarkers above target had significantly increased risks compared with those with all at target: fatal and nonfatal ASCVD (adjusted hazard ratio 1.59; 95% CI 1.24, 2.03) and total CVD (adjusted hazard ratio 1.44; 95% CI 1.13, 1.83). Cardiovascular risk increased progressively as fewer biomarkers achieved target levels (all Ptrend < 0.001), with stronger associations in patients with shorter diabetes duration (<2 years vs. ≥2 years). CONCLUSIONS Elevated hsCRP, LDL-C, and Lp(a) showed dose-dependent associations with cardiovascular risk in patients with type 2 diabetes, supporting their control in cardiovascular risk prevention.