Work

Association between atherogenic index of plasma and microvascular complications in patients with type 2 diabetes achieving low-density lipoprotein cholesterol targets: a real-world cohort study

Year: 2026

Type: article

Abstract: Background: Despite achieving low-density lipoprotein cholesterol (LDL-C) targets, patients with type 2 diabetes mellitus (T2DM) remain at significant risk for microvascular complications. We aimed to investigate whether the atherogenic index of plasma (AIP), a marker of atherogenic dyslipidaemia, is associated with these complications in a real-world cohort of patients with controlled LDL-C. Methods: We conducted a retrospective cohort study using electronic health records from community health centres in Shenzhen, China (2018-2024). We included 16,469 participants with T2DM and LDL-C<2.6 mmol/L at baseline, categorising them into tertiles (T1-3) based on baseline AIP. The primary outcome was a composite of incident diabetic retinopathy, diabetic nephropathy, and diabetic peripheral neuropathy, identified via ICD-10 codes. We used multivariable Cox proportional hazards models to assess associations. Results: During a median follow-up of 4.6 years, 1,056 participants developed microvascular complications. We observed a graded association between AIP tertiles and the risk of microvascular complications. Participants in T3 had a significantly higher risk of total microvascular complications than those in T1 (hazard ratio (HR) = 1.34; 95% confidence interval (CI) = 1.15-1.56), while T2 showed no statistically significant increase in risk (HR = 1.10; 95% CI = 0.94-1.28). Specifically, compared to T1, T3 participants had significantly higher risks of diabetic nephropathy (HR = 1.62; 95% CI = 1.30-2.01) and diabetic peripheral neuropathy (HR = 1.39; 95% CI = 1.13-1.70), while no statistically significant association was found for diabetic retinopathy risk (HR = 1.23; 95% CI = 0.93-1.63). In contrast, compared with T1 participants, those in T2 had higher risks of nephropathy (HR = 1.28; 95% CI = 1.02-1.59), but no statistically significant associations were found for diabetic peripheral neuropathy or diabetic retinopathy. Conclusions: We found that AIP is independently associated with increased risk of microvascular complications, particularly diabetic nephropathy and diabetic peripheral neuropathy, even in T2DM patients achieving LDL-C targets. These results suggest that AIP may serve as a simple, lipid-based marker to help identify patients with residual microvascular risk beyond conventional LDL-C control.

Source: Journal of Global Health

DOI: 10.7189/jogh.16.04350