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.
10 affiliations
- 1Folkhälsan Research Center, Helsinki, Finland.
- 2Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- 3Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
- 4Department of Cardiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- 5Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- 6Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- 7Folkhälsan Research Center, Helsinki, Finland. [email protected].
- 8Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. [email protected].
- 9Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland. [email protected].
- 10Department of General Practice and Primary Health Care, University of Helsinki, Helsinki University Hospital, P.O. Box 20, Helsinki, FIN-00014, Finland. [email protected].
Abstract
Background
Non-ST-elevation myocardial infarction (NSTEMI) has become the main myocardial infarction subtype in type 1 diabetes compared to ST-elevation myocardial infarction (STEMI), accounting for nearly 80% of myocardial infarction-related hospitalizations. Yet, prior studies in type 1 diabetes have assessed myocardial infarctions as a single entity, potentially overlooking clinically relevant heterogeneity between subtypes in risk assessment. We aimed to study the role of lipids, apolipoproteins, insulin resistance, and the metabolic syndrome in risk stratification of all myocardial infarctions, STEMI and NSTEMI in individuals with type 1 diabetes stratified by the presence of microvascular complications.Methods
The current study is an observational follow-up study of 4215 individuals from the Finnish Diabetic Nephropathy Study. We verified 449 first-ever myocardial infarctions from medical records and death certificates and further categorized them into either STEMI or NSTEMI. Multivariable Cox regression models were used to assess the effect of a comprehensive lipid and apolipoprotein panel and insulin resistance on the risk of all myocardial infarctions, STEMI, and NSTEMI. Risk estimates for all myocardial infarctions were additionally stratified based on the presence of microvascular complications.Results
For STEMI, apolipoprotein A-I (ApoA-I) (hazard ratio per 1 standard deviation 0.77 [95% confidence interval 0.60-0.99]; P = 0.043), HDL2 cholesterol (HDL2-C) (0.72 [0.55-0.95]; P = 0.019), and HDL-C/total cholesterol ratio (0.76 [0.59-0.98]; P = 0.035) were associated with reduced risk, while no variables were associated with increased risk. Regarding NSTEMI, apolipoprotein B-100 (ApoB-100) (1.31 [1.15-1.50]; P < 0.001) and ApoB-100 to apolipoprotein A-I (ApoA-I) ratio (1.29 [1.18-1.41]; P < 0.001) showed the strongest association with an increased risk, while the HDL-C/total cholesterol ratio was associated with reduced risk (0.71 [0.62-0.82]; P < 0.001). In stratified analyses, associations between selected lipid and apolipoprotein variables and myocardial infarction risk appeared stronger among individuals without microvascular complications. Higher estimated glucose disposal rate, indicating lesser insulin resistance, was associated with reduced risk of both STEMI (0.82 [0.73-0.92]; P < 0.001) and NSTEMI (0.92 [0.86-0.99]; P = 0.024).Conclusions
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.
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BibTeX
@article{smidtslund2026lipids,
title = {{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.}},
author = {Patrik Smidtslund and Fanny Jansson Sigfrids and Valma Harjutsalo and Ville Thorn and Marja-Riitta Taskinen and Per-Henrik Groop and Lena M Thorn and FinnDiane Study Group},
journal = {Cardiovascular diabetology},
year = {2026},
month = aug,
doi = {10.1186/s12933-026-03315-9},
url = {https://europepmc.org/article/MED/42958254},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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.
AU - Patrik Smidtslund
AU - Fanny Jansson Sigfrids
AU - Valma Harjutsalo
AU - Ville Thorn
AU - Marja-Riitta Taskinen
AU - Per-Henrik Groop
AU - Lena M Thorn
AU - FinnDiane Study Group
PY - 2026
DA - 2026/08/01
JO - Cardiovascular diabetology
DO - 10.1186/s12933-026-03315-9
UR - https://europepmc.org/article/MED/42958254
AB - Background Non-ST-elevation myocardial infarction (NSTEMI) has become the main myocardial infarction subtype in type 1 diabetes compared to ST-elevation myocardial infarction (STEMI), accounting for nearly 80% of myocardial infarction-related hospitalizations. Yet, prior studies in type 1 diabetes have assessed myocardial infarctions as a single entity, potentially overlooking clinically relevant heterogeneity between subtypes in risk assessment. We aimed to study the role of lipids, apolipoproteins, insulin resistance, and the metabolic syndrome in risk stratification of all myocardial infarctions, STEMI and NSTEMI in individuals with type 1 diabetes stratified by the presence of microvascular complications.Methods The current study is an observational follow-up study of 4215 individuals from the Finnish Diabetic Nephropathy Study. We verified 449 first-ever myocardial infarctions from medical records and death certificates and further categorized them into either STEMI or NSTEMI. Multivariable Cox regression models were used to assess the effect of a comprehensive lipid and apolipoprotein panel and insulin resistance on the risk of all myocardial infarctions, STEMI, and NSTEMI. Risk estimates for all myocardial infarctions were additionally stratified based on the presence of microvascular complications.Results For STEMI, apolipoprotein A-I (ApoA-I) (hazard ratio per 1 standard deviation 0.77 [95% confidence interval 0.60-0.99]; P = 0.043), HDL2 cholesterol (HDL2-C) (0.72 [0.55-0.95]; P = 0.019), and HDL-C/total cholesterol ratio (0.76 [0.59-0.98]; P = 0.035) were associated with reduced risk, while no variables were associated with increased risk. Regarding NSTEMI, apolipoprotein B-100 (ApoB-100) (1.31 [1.15-1.50]; P < 0.001) and ApoB-100 to apolipoprotein A-I (ApoA-I) ratio (1.29 [1.18-1.41]; P < 0.001) showed the strongest association with an increased risk, while the HDL-C/total cholesterol ratio was associated with reduced risk (0.71 [0.62-0.82]; P < 0.001). In stratified analyses, associations between selected lipid and apolipoprotein variables and myocardial infarction risk appeared stronger among individuals without microvascular complications. Higher estimated glucose disposal rate, indicating lesser insulin resistance, was associated with reduced risk of both STEMI (0.82 [0.73-0.92]; P < 0.001) and NSTEMI (0.92 [0.86-0.99]; P = 0.024).Conclusions 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.
SN - 1475-2840
ER -