Association of Atherogenic Index of Plasma with Left Ventricular Diastolic Dysfunction in Patients with Diabetic Retinopathy
Jai Mangla, Ganesh Sethuraman, Ashok GovindarajObjectives:
Atherogenic index of plasma (AIP), calculated as log10 (triglycerides/High Density Lipoproteincholesterol), offers a low-cost index of atherogenic dyslipidemia, whereas left ventricular diastolic dysfunction (LVDD) marks the earliest subclinical stage of diabetic cardiomyopathy and falls disproportionately on women. Here, we quantify how AIP relates to LVDD among women living with type 2 diabetes mellitus (T2DM) and diabetic retinopathy (DR).
Materials and Methods:
We assessed 125 women with T2DM and fundoscopically confirmed DR in a hospital-based, cross-sectional observational design. AIP was calculated from a fasting lipid profile. LVDD was diagnosed by transthoracic echocardiography with tissue Doppler imaging, graded per the 2016 The American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) recommendations. The independent association of AIP with LVDD and its optimal discriminative cut-off were quantified using multivariable logistic regression together with receiver operating characteristic (ROC) curve analysis.sssssse
Results:
Fifty of 125 women (40.0%) had LVDD, and AIP was significantly higher in this group than in the remainder (0.70 ± 0.13 vs. 0.51 ± 0.17, p < 0.001). AIP correlated positively with the average E/e′ ratio (r = 0.29, p = 0.001). After multivariable adjustment for age, body mass index, glycated hemoglobin (HbA1c), duration of T2DM, systolic blood pressure, and DR severity, the association between AIP and LVDD persisted (adjusted odds ratio 2.34 per 0.1-unit increase, 95% CI 1.35–4.05, p = 0.002). ROC analysis identified an exploratory AIP cut-off of 0.65 for distinguishing women with LVDD (area under the curve 0.81, 95% CI 0.73–0.89; sensitivity 68%; specificity 83%). AIP did not differ significantly between non-proliferative and proliferative DR (0.57 ± 0.17 vs. 0.61 ± 0.19, p = 0.253).
Conclusion:
Among women with T2DM and established DR, subclinical LVDD tracked independently with AIP. AIP may be a potentially useful marker of LVDD, but the exploratory cut-off of 0.65 requires prospective external validation before any clinical application.