ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1591893
Nonlinear association between low-density lipoprotein cholesterol and risk of prediabetes: a retrospective cohort study based on Chinese adults
Provisionally accepted
- 1Northern Theater Command General Hospital, Shenyang, Liaoning Province, China
- 2Yangzhou University, Yangzhou, China
- 3Xuyi People's Hospital, Huai'an, China
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The pathogenesis of prediabetes remains complex, particularly regarding the interactions between lipid metabolism disorders and glucose metabolism abnormalities, which warrant in-depth exploration. Low-density lipoprotein cholesterol (LDL-C) is an important risk factor for atherosclerosis and cardiovascular disease. However, the relationship between LDL-C and prediabetes has been less extensively studied. Therefore, we conducted a retrospective cohort study to investigate this association.This secondary retrospective cohort study utilized data from 100,608 Chinese adults. Cox proportional hazards regression models were used to examine the relationship between LDL-C and prediabetes risk. Restricted cubic spline regression and smooth curve fitting were used to explore the nonlinear relationship between LDL-C and prediabetes. A two-piecewise Cox proportional hazards regression model identified inflection points. In addition, a series of subgroup and sensitivity analyses were performed to confirm the robustness of our results.After adjusting for confounding covariates, LDL-C was positively associated with prediabetes (HR:1.49, 95% CI: 1.40-1.58, P < 0.0001). The two-piecewise Cox model identified an inflection point of 2.19 for LDL-C (P < 0.001 for log-likelihood ratio test). When LDL-C ≤ 2.19, LDL-C was positively associated with the risk of prediabetes (HR: 2.02, 95% CI: 1.71-2.36, P < 0.0001). In contrast, when LDL-C > 2.19, LDL-C was associated with a relatively lower risk of prediabetes (HR: 1.49, 95% CI: 1.39-1.59, P < 0.0001). Sensitivity and subgroup analyses confirmed the stability and consistency of this positive association within the general population.This study reveals a nonlinear positive association between LDL-C levels and prediabetes risk in Chinese adults after adjusting for confounders. Dynamic monitoring of LDL-C levels may help identify individuals at high risk for prediabetes. Timely dietary and lifestyle modifications could potentially reduce the risk of prediabetes. These findings offer new insights for prediabetes prevention and treatment.
Keywords: Low-density lipoprotein cholesterol, prediabetes, cohort study, Nonlinearly, prevention
Received: 11 Mar 2025; Accepted: 10 Jun 2025.
Copyright: © 2025 He, Zhang and Sha. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wei Sha, Yangzhou University, Yangzhou, China
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