Key result
eGFR 30-59 in diabetes is linked to ~43% higher CVD risk despite optimal LDL-C.
Why the study?
The association between lipid parameters and CVD, as well as the impact of kidney function on this relationship, has not been thoroughly evaluated in patients with T2DM.
Does the association between LDL-C levels and cardiovascular disease risk vary by kidney function in patients with type 2 diabetes mellitus?
Population
2,343,882 subjects with T2DM from the Korean National Health Insurance Service Cohort
Comparison
eGFR groups (≥60, 30-59, <30 mL/min/1.73 m2) and LDL-C categories vs reference (eGFR ≥60 and LDL-C <70 mg/dL)
Design
Cohort study
Follow-up
Until December 2020
Authors
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Impaired kidney function may raise CVD risk at lower LDL-C in T2DM; leaves open whether tailored targets improve outcomes.
Cohort (n=2,343,882)
Does the association between LDL-C levels and cardiovascular disease risk vary by kidney function in patients with type 2 diabetes mellitus?
Hazard Ratio: 1.43 (95% CI 1.37–1.48)
Absolute Event Rate: 20.4% vs 9.4%
In patients with type 2 diabetes, the cardiovascular risk associated with LDL-C levels is significantly modified by kidney function, suggesting that patients with reduced eGFR may require lower LDL-C targets.
Lee et al. (2025) conducted a cohort in Type 2 diabetes mellitus (n=2,343,882). Reduced kidney function (eGFR 30-59 mL/min/1.73 m2) with LDL-C <70 mg/dL vs. Normal kidney function (eGFR ≥60 mL/min/1.73 m2) with LDL-C <70 mg/dL was evaluated on Incidence of cardiovascular disease (composite of newly diagnosed myocardial infarction and ischemic stroke) (HR 1.43, 95% CI 1.37-1.48). In patients with type 2 diabetes, cardiovascular disease risk increased by 43% in those with eGFR 30-59 and 3.3-fold in those with eGFR <30, even at optimal LDL-C levels <70 mg/dL.