ORIGINAL RESEARCH article

Front. Cardiovasc. Med.

Sec. Lipids in Cardiovascular Disease

Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1549517

Decrease in Low-Density Lipoprotein Cholesterol is Associated with an Increased Risk of Mortality in Patients with Diabetes Mellitus

Provisionally accepted
Yun Gi KimYun Gi Kim1Joo Hee JeongJoo Hee Jeong1Kyungdo HanKyungdo Han2Seung-Young RohSeung-Young Roh3Chang-Ok SeoChang-Ok Seo1Yeji KimYeji Kim1Hyoung Seok LeeHyoung Seok Lee1Jaemin ShimJaemin Shim1Young-Hoon KimYoung-Hoon Kim1Jong-Il ChoiJong-Il Choi1*
  • 1Korea University Anam Hospital, Seoul, Republic of Korea
  • 2Soongsil University, Seoul, Republic of Korea
  • 3Korea University Guro Hospital, Seoul, Republic of Korea

The final, formatted version of the article will be published soon.

Select one of your emails

You have multiple emails registered with Frontiers:

Notify me on publication

Please enter your email address:

If you already have an account, please login

You don't have a Frontiers account ? You can register here

Research on the effect of low-density lipoprotein (LDL)-cholesterol levels and its serial change on all-cause mortality is limited. This study investigated serial change in LDL-cholesterol and its association with all-cause mortality or sudden cardiac arrest (SCA) in patients with diabetes mellitus. Data was obtained from the nationwide health insurance database of South Korea. Patients with diabetes mellitus who underwent health screening between 2009 and 2012 and those with 4-year follow-up health screening data were included. Patients were further stratified by statin use and change in LDL-cholesterol levels during this 4-year interval. The primary and secondary outcomes were all-cause mortality and SCA, respectively. Outcomes were followed up from the day of health screening till December 2018. Kaplan-Meier analysis and the Cox-proportional hazards model were used to evaluate associations between LDL-cholesterol changes, all-cause mortality, and SCA. A total of 1,329,982 patients were included, including 532,260 patients who did not receive statin therapy (non-statin users). Compared to statin users, non-statin users had a higher incidence of all-cause mortality (incidence rate 13.9–16.4 per 1,000 person-years) and SCA (1.6–1.9). Among non-statin users, patients with decreased LDL-cholesterol had the highest risk of all-cause mortality (adjusted hazard ratio 1.26, 95% confidence interval 1.21–1.31, P<0.001) and SCA (1.21, 1.10–1.34, P <0.001). Thus, in patients with diabetes mellitus not receiving statin therapy, a decrease in LDL-cholesterol may be a surrogate marker for all-cause mortality and SCA.

Keywords: Cholesterol, LDL cholesterol, Diabetes Mellitus, Sudden cardiac arrest, All-cause mortality

Received: 21 Dec 2024; Accepted: 18 Apr 2025.

Copyright: © 2025 Kim, Jeong, Han, Roh, Seo, Kim, Lee, Shim, Kim and Choi. 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: Jong-Il Choi, Korea University Anam Hospital, Seoul, Republic of Korea

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Supplementary Material