Discussion
acute myocardial infarction, dyslipidaemia, CHD, T2DM, diabetes
ACUTE MYOCARDIAL INFARCTION, DISEASE, EVENT, SECONDARY, CORONARY HEART DISEASE, DIABETES
Despite the determining role of dyslipidaemia in T2DM, the molecular mechanisms and the involvement of the specific lipid species behind this role are not yet well understood [T2DM is currently the most prevalent form of diabetes, affecting around 380 million people worldwide, and accounting for 90% of all cases. It is also on the rise, mainly due to the prevalence of sedentary lifestyles and inadequate diets [Current predictive models in T2DM research combine classic biomarkers and risk factors, including serum parameters, anthropometric characteristics, and factors related to lifestyle. On the FINDRISC questionnaire [This study showed that the predictive capacity of the clinical variables was significantly improved by the addition of 15 lipid species, selected by RSF from a total of 440 determined by our experimental approach. To the best of our knowledge, this is the first time that a lipidomic study has been carried out in a risk population of CHD patients to predict diabetes incidence. Nevertheless, a previous study in a non-CVD population also observed an improvement in the prediction capacity of their model when lipids were added to conventional risk factors [Unlike the study by Razquin et al., which described a lipid profile based only on lipid classes associated with T2DM incidence, our study shows that we need to analyse individual lipid species to accurately differentiate the directionality of the association with T2DM. We identified four members of the PE lipid family, of which two, PE(16:0_18:1), and PE(O-20:0/18:0), were associated with the development of T2DM, whereas the other two, PE(16:1_18:1) and PE(18:0_18:2), were protective against T2DM. Moreover, while the relationship of PE with T2DM risk has been previously reported, the specific species and isomers have not been described previously [Similarly, two compounds from the PC family were identified by the RSF as associated with T2DM in opposite ways, one protecting and another promoting the disease. PC(P-16:0/18:1) is linked with a protective role against the disease, while PC(P-16:1/18:0) is associated with diabetes development. PC is the only phospholipid essential for the assembly, secretion, and regulation of lipoproteins such as LDL and HDL [In contrast, isomers identified within the TGs, phosphatidylserines (PSs), and LPC are unidirectional. Among these three families, LPC is the only one with a protective role in preventing diabetes development. LPC is a hydrolysis product derived from the catalysis of phosphatidylcholine by phospholipase AFinally, it is important to mention the limitations of this study. Firstly, this research is based on a long-term, closely controlled dietary intervention, which, despite ensuring the quality of the study, may not reflect the level of compliance in a free-living population.The second limitation is that the incidence of T2DM was not the primary endpoint of the CORDIOPREV trial, although it was a secondary objective of this study. Indeed, our study has the limitation that the incident-DIAB group has higher baseline glucose levels and an unbalanced number of men and women included as participants. In fact, this population was included in the CORDIOPREV study without any type of selection, therefore representing the sexual dimorphism existent in CHD, and any attempt to balance the number of men and women may introduce a bias. Moreover, the study included patients with coronary heart disease, which limits our findings to people with these characteristics and precludes its generalization to healthy individuals. Although diabetes prediction is extremely important since patients with acute myocardial infarction and T2DM have a considerably higher risk of developing a new cardiovascular event than those without T2DM [