Suboptimal lipid management is associated with subclinical left ventricular dysfunction in type 2 diabetes mellitus patients with preserved ejection fraction: a cardiac magnetic resonance feature-tracking study

Despite guideline recommendations for stringent lipid-lowering targets, achievement rates in high cardiovascular risk patients with type 2 diabetes mellitus (T2DM) remain suboptimal, contributing to residual cardiovascular risk. This study aimed to investigate the relationship between achieving low-density lipoprotein cholesterol (LDL-C) target and subclinical cardiac function in patients with T2DM, utilising cardiac magnetic resonance feature tracking (CMR-FT). This study recruited 118 patients with T2DM from January 2019 to December 2024. Differences in left ventricular function characteristics were compared between patients who achieved the LDL-C target and those who did not. Multivariable linear regression and logistic regression analyses were employed to investigate the association between lipid management and subclinical left ventricular dysfunction. The robustness of the analysis was verified through sensitivity analyses, including treating LDL-C as a continuous variable and excluding specific subpopulations. Of the 118 patients included in the study, 46 (38.9%) met the LDL-C target (LDL-C target achieved group), while 72 (61.1%) did not (LDL-C target nonachieved group). The nonachieved group demonstrated significant signs of adverse cardiac remodelling and impaired myocardial deformation (GLPS: -15.4% ± 3.1% vs. -17.3% ± 3.3%; RI: 0.84 [0.68, 1.08] vs. 0.77 [0.64, 0.88]; P < 0.05). After multivariable adjustment, the LDL-C target nonachieved was independently associated with GLPS impairment (β = -1.53, P = 0.009) and a 4.0-fold increased risk of GLPS abnormality (OR = 4.0, P = 0.006). Sensitivity analyses confirmed the robustness of the findings. When treating LDL-C as a continuous variable, it remained significantly inversely associated with GLPS (β = -0.61, P = 0.040). After excluding patients on PCSK9 inhibitors and those with extreme diabetes duration, failure to achieve the LDL-C target remained significantly associated with reduced GLPS (β = -1.71, P = 0.009) and an increased risk of abnormal GLPS (OR = 3.62, P = 0.021). In high cardiovascular risk patients with T2DM, suboptimal lipid management is associated with subclinical myocardial dysfunction. These results underscore the clinical importance of rigorous lipid control and highlight the potential role of CMR-FT in the early identification of patients who may benefit from intensified management.