A recent study published in Cardiovascular Diabetology revealed a groundbreaking finding that low levels of LDL cholesterol can significantly improve coronary artery disease, such as atherosclerosis, in type 1 diabetes patients, emphasizing the need for lipid management in such cohorts.
Due to hastened atherosclerosis, there is an increased risk of developing coronary artery disease (CAD). Certain studies suggest that functional and quantitative abnormalities in lipoproteins are involved in this; however, the molecular mechanism behind this is unexplored. Some T1D patients who have been living with the condition for decades are free from atherosclerosis. Thus, the study aimed to explore how lipoproteins and metabolites are associated with coronary arteries free from atherosclerosis in long-term T1D individuals.
Researchers conducted a cross-sectional study involving 102 T1D individuals and 61 control participants. Circulating lipids and metabolites in serum were quantified using high-throughput nuclear magnetic resonance (NMR) spectroscopy. Computed tomography coronary angiography (CTCA) was employed to diagnose coronary heart disease in participants who were not previously diagnosed.
The mean diabetes duration was 50.6 years. Results revealed that a lower level of LDL particles significantly reduced atherosclerosis. Normal Coronary Artery Calcium (CAC) was also reported in participants with lower particle concentration of all LDL subclasses, regardless of sex, age, eGFR, and statin treatment. Compared to the control group, the diabetes group had significantly lower concentrations of LDL, VLDL, and IDL, independent of the presence of CAD.
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Key highlights
- In long-term survivors of type 1 diabetes, lower levels of all LDL particle types were significantly associated with a reduced presence of coronary atherosclerosis, even after adjusting for statin use.
- The findings highlight the importance of initiating lipid-lowering treatment early in type 1 diabetes to prevent the development of coronary artery disease (CAD).
- A subset of long-term type 1 diabetes survivors may possess genetic or environmental protective factors that reduce their risk of CAD, independent of statin therapy, warranting further investigation.
Source
Narum, M., Christensen, J.J., Holven, K.B. et al. Low LDL particle levels are associated with coronary arteries free from atherosclerosis in long-term type 1 diabetes: the Dialong study. Cardiovasc Diabetol 24, 297 (2025). https://doi.org/10.1186/s12933-025-02844-z
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Study finds low LDL particle levels protect long-term type 1 diabetes patients from coronary atherosclerosis, underscoring importance of aggressive lipid management.
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