The Association Between Markers of Lipid Homeostasis, Inflammation, and Atherosclerosis Index in Patients with Type 2 Diabetes and Coronary Heart Disease Stratified by Glycemic Control: A Cross-Sectional Study.

Objective: This cross-sectional study investigates the relationship between systemic markers of lipid homeostasis, inflammation, and atherosclerosis index (AI) in patients with both type 2 diabetes and coronary heart disease (CHD), stratified by their glycemic control status.

Methods: A total of 120 patients with type 2 diabetes and CHD were included and stratified into a Good Glycemic Control group (GGC, HbA1c<7%, n=72) and a Poor Glycemic Control group (PGC, HbA1c≥7%, n=48). AI was assessed using brachial-ankle pulse wave velocity (baPWV), and coronary stenosis was evaluated angiographically. Blood lipids, glucose metabolism indicators (Fasting Plasma Glucose [FPG], Fasting Insulin [FINS], HOMA-IR), and serum inflammatory markers (TNF-α, IL-1β, hs-CRP) were quantified. Pearson correlation and logistic regression analyses were used to assess associations and identify risk factors for AI.

Results: The PGC group exhibited significantly higher AI and coronary stenosis scores, a more atherogenic lipid profile (higher TC, TG, LDL-C; lower HDL-C), and elevated HOMA-IR and inflammatory markers compared to the GGC group (all P<0.05). Baseline characteristics and medication use were similar, except for higher insulin use in the PGC group. Pearson analysis revealed that AI was positively correlated with hs-CRP, TG, coronary stenosis scores, and HOMA-IR (all P<0.05). Logistic regression identified hs-CRP, TG, coronary stenosis score, and HOMA-IR as independent risk factors for increased AI.

Conclusion: In patients with type 2 diabetes and CHD, poor glycemic control is strongly associated with increased arterial stiffness, dyslipidemia, systemic inflammation, and insulin resistance. These findings highlight the critical, intertwined roles of these pathways in atherosclerosis and underscore the necessity of a multifactorial approach to cardiovascular risk management in this high-risk population.