What is the clinical evidence from this study?

Study design: Cohort. Population: Prediabetes (n=100069). Intervention: Atherogenic index of plasma (AIP) vs. Lower AIP levels. Primary outcome: Incident prediabetes (HR 1.41, 95% CI 1.31-1.52, p=< 0.0001).

August 10, 2023Cardiovascular Diabetology89 citationsOpen Access

Nonlinear relationship between atherogenic index of plasma and the risk of prediabetes: a retrospective study based on Chinese adults

Q: What are the key findings of this study?

The atherogenic index of plasma was positively and non-linearly associated with the risk of prediabetes, with a 41% increased risk for every unit increase in AIP (HR 1.41).

XZXiaodan Zheng XZXin Zhang YHYong Han

Key Result

The atherogenic index of plasma was positively and non-linearly associated with the risk of prediabetes, with a 41% increased risk for every unit increase in AIP (HR 1.41).

Study Design

Type

Cohort (n=100,069)

Multicenter

Yes

Structured PICO

Does a higher atherogenic index of plasma increase the risk of incident prediabetes in Chinese adults?

Population

100,069 Chinese adults over 20 years old without prediabetes at baseline, followed for an average of 3.12 years to assess the incidence of prediabetes.

Exposure

Higher Atherogenic Index of Plasma (AIP), calculated as Log10 (triglyceride/high-density lipoprotein cholesterol)

Comparator

Lower Atherogenic Index of Plasma (AIP) groups (quartiles) or continuous comparison

Outcome

Incident prediabetes (impaired fasting glucose levels, FPG: 5.6-6.9 mmol/l) during follow-upsurrogate

The atherogenic index of plasma is positively and non-linearly associated with the risk of developing prediabetes, suggesting its potential utility as a biomarker for early glucose dysmetabolism.

Main Result

Hazard Ratio: 1.41 (95% CI 1.31–1.52)

p-value: p=< 0.0001

Limitations

Prediabetes may have been underestimated due to a lack of experimental OGTT.
The database lacks information on atherosclerosis, lipid-regulating medication, and the presence or absence of hyperlipidemia.
Uncontrolled or unmeasured confounders, including diet and exercise, cannot be entirely ruled out.
Triglycerides and HDL-C were measured only at baseline, not capturing fluctuations over time.

Abstract

BACKGROUND: The atherogenic index of plasma (AIP) can reflect the burden of atherosclerosis. Hyperglycemia is one of the leading causes of atherosclerosis. However, the relationship between AIP and prediabetes is rarely studied. Therefore, we aimed to explore the relationship between AIP and prediabetes. METHODS: This retrospective cohort study recruited 100,069 Chinese adults at the Rich Healthcare Group from 2010 to 2016. AIP was calculated according to Log10 (triglyceride/high-density lipoprotein cholesterol) formula. Cox regression method, sensitivity analyses and subgroup analyses were used to examine the relationship between AIP and prediabetes. Cox proportional hazards regression with cubic spline functions and smooth curve fitting was performed to explore the non-linearity between AIP and prediabetes. The two-piece Cox proportional hazards regression model was used to determine the inflection point of AIP on the risk of prediabetes. RESULTS: After adjusting for confounding covariates, AIP was positively associated with prediabetes (HR: 1.41, 95%CI: 1.31-1.52, P 0.03, their association was not significant (HR: 1.04, 95%CI: 0.91-1.19, P = 0.5528). CONCLUSION: This study shows that AIP was positively and non-linearly associated with the risk of prediabetes after adjusting for other confounding factors. When AIP ≤ 0.03, AIP was positively associated with the risk of prediabetes.

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