Association between low-density lipoprotein cholesterol and sudden cardiac arrest in people with diabetes mellitus

Yun Gi Kim, Joo Hee Jeong, Kyung Do Han, Seung Young Roh, Kyongjin Min, Hyoung Seok Lee, Yun Young Choi, Jaemin Shim, Jong Il Choi, Young Hoon Kim

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Dyslipidemia measured as low-density lipoprotein (LDL)-cholesterol is an established risk factor of cardiovascular disease, which is more pronounced in diabetes population. Less is known about the association of LDL-cholesterol level and sudden cardiac arrest (SCA) risk in diabetes mellitus patients. This study investigated the association of LDL-cholesterol level and SCA risk in diabetes population. Methods: This study was based on Korean National Health Insurance Service database. Patients who received general examination from 2009 to 2012 and diagnosed as type 2 diabetes mellitus were analyzed. Primary outcome was defined as SCA event identified with International Classification of Disease code. Results: A total of 2,602,577 patients were included, with total follow-up duration of 17,851,797 person * year. Mean follow-up duration was 6.86 years, and 26,341 SCA cases were identified. Overall incidence of SCA was highest in the lowest LDL-cholesterol group (< 70 mg/dL) and decreased in a linear manner as LDL-cholesterol rises, till 160 mg/dL. Adjustment of covariates resulted in U-shape association, with highest risk of SCA in the highest LDL-cholesterol group (≥ 160 mg/dL) followed by lowest LDL-cholesterol group (< 70 mg/dL). In subgroup analysis, U-shape association between SCA risk and LDL-cholesterol was more pronounced in male, non-obese people, and those who did not use statins. Conclusions: In people with diabetes, the association between SCA and LDL-cholesterol level was U-shaped with highest and lowest LDL-cholesterol group having higher risk of SCA than others. Low LDL-cholesterol level can be a surrogate marker for increased risk of SCA in people with diabetes mellitus and this paradoxical association should be recognized and extended to clinical preventive measures.

Original languageEnglish
Article number36
JournalCardiovascular diabetology
Issue number1
Publication statusPublished - 2023 Dec

Bibliographical note

Funding Information:
This work was supported by a Korea University grant (J-I.C), a grant from Korea University Anam Hospital, Seoul, Republic of Korea (J-I.C), and in part by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT, Ministry of Science and ICT) (No. 2021R1A2C2011325 to J-I.C). The funders had no role in data collection, analysis, or interpretation; trial design; patient recruitment; or any other aspect pertinent to the study.

Publisher Copyright:
© 2023, The Author(s).


  • Diabetes mellitus
  • LDL
  • Lipoproteins
  • Sudden cardiac arrest

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine


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