ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1652396
This article is part of the Research TopicDiabetes Complications: Navigating Challenges and Unveiling New SolutionsView all 8 articles
The interaction between blood lipids and ASCVD increases the risk of DKD: A nonlinear relationship transforms into a linear relationship, a cross-sectional study
Provisionally accepted
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Background:Atherosclerotic cardiovascular disease (ASCVD) and diabetic kidney disease (DKD) are interconnected vascular complications in diabetes, with dyslipidemia playing a key role. The modifying effect of ASCVD on the lipid-DKD relationship in diabetic patients without lipid-lowering treatment remains unclear. Methods:This retrospective study included 26,476 type 2 diabetic patients without lipid-lowering therapy. Associations between lipids (LDL-C, TC, TG, HDL-C) and DKD risk were analyzed using regression and restricted cubic spline (RCS) curves analysis. Both multiplicative and additive interactions between lipids and ASCVD were assessed. Results: HDL-C showed a significant linear association with DKD. RCS analyses revealed distinct patterns based on ASCVD status: significant threshold effects for LDL-C (2.68 mmol/L), TC (4.29 mmol/L), TG (2.48 mmol/L), and HDL-C (1.64 mmol/L) on DKD risk were observed only in diabetic patients without ASCVD. No significant nonlinear threshold effects were found for LDL-C, TC, HDL-C on DKD risk in diabetic patients with ASCVD. LDL-C and TC showed continuous increases in DKD risk without a discernible safe threshold in diabetic patients with ASCVD.Crucially, a strong synergistic interaction existed between ASCVD and both TC (RERI=7.46, AP=0.25, SI=1.34) and LDL-C (RERI=9.91, AP=0.27, SI=1.38) , significantly amplifying their adverse effects on renal injury. Conclusion: ASCVD amplifies the detrimental renal effects of TC and LDL-C and eliminates protective lipid thresholds in diabetic patients. Consequently, lipid management in diabetic patients should be individualized: strict control of TC and LDL-C is prioritized for those with ASCVD, while consideration of lipid threshold effects is key for those without ASCVD.
Keywords: Diabet Mellitus Type 2, ASCVD, diabetic kideny disease, Lipids, LDL-C, TC
Received: 23 Jun 2025; Accepted: 01 Aug 2025.
Copyright: © 2025 Zijie, li, shi, zhang, han and zhang. 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: Liu Zijie, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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