American Diabetes Association
Supplemental_Material_ceramide_paper_v.2.2.2_diabetes_journal_Revision_clean.pdf (693.07 kB)

Ceramides as risk markers for future cardiovascular events and all-cause mortality in long-standing type 1 diabetes

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posted on 2023-07-21, 17:51 authored by Asger Wretlind, Viktor R. Curovic, Tommi Suvitaival, Simone Theilade, Nete Tofte, Signe A. Winther, Tina Vilsbøll, Henrik Vestergaard, Peter Rossing, Cristina Legido-Quigley

Ceramides are lipid molecules involved in inflammation-related signaling. Recent studies have shown that higher amounts of specific circulating ceramides and their ratios are associated with future development of cardiovascular (CV) disease (CVD). We examined the associations between serum ceramide levels with CVD, kidney failure, and all-cause mortality in individuals with longstanding type 1 diabetes (T1D). We included 662 participants with T1D and 6-year follow-up, with a mean age of 55 years and mean diabetes duration of 33 years. Baseline serum samples were analyzed using liquid chromatography-mass spectrometry. Six predefined ceramide levels were measured, and predefined ratios were calculated. Adjusted Cox regression analyses on ceramide levels in relation to future CV events (CVE), kidney failure and all-cause mortality were performed, with and without adjustment for age, sex, BMI, LDL, triglycerides, systolic blood pressure, HbA1C, history of CVD, smoking status, statin use, eGFR and UAER. The ceramide ratio cer(d18:1/18:0)/cer(d18:1/24:0) was significantly associated with risk of CVE (HR = 1.33, P = 0.01) and all-cause mortality (HR = 1,48, P = 0.01) before and after adjustments. All five investigated ceramide ratios were associated with kidney failure, before adjusting for the kidney markers eGFR and UAER. In this study we demonstrate specific ceramides and ratios associated with 6-year cardiovascular risk and all-cause mortality in a T1D cohort. This highlights the strength of ceramide association with vascular complications and presents a new potential tool for early risk assessment if validated in other cohorts.


Funding was provided by Steno Diabetes Center Copenhagen, Gentoſte, Denmark. We acknowledge the support from the Novo Nordisk Foundation grant NNF14OC0013659 “PROTON Personalizing treatment of diabetic nephropathy”.


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