Serum Fibroblast Growth Factor 19 (FGF19) Levels Are Associated With Atherogenic Dyslipidemia in Patients With Type 2 Diabetes
Type 2 diabetes (T2D) affects over 537 million adults worldwide, and nearly two-thirds of these patients die from cardiovascular complications—largely driven by atherogenic dyslipidemia, a harmful profile of high triglycerides (TG), low “good” high-density lipoprotein cholesterol (HDL-C), and high “bad” low-density lipoprotein cholesterol (LDL-C) that fuels artery-clogging plaque. Yet until recently, there was no reliable way to spot this high-risk condition early in T2D patients. A 2021 study from researchers at Central South University’s Second Xiangya Hospital in China suggests a promising solution: serum fibroblast growth factor 19 (FGF19), a hormone made in the small intestine that regulates lipid and glucose metabolism, may act as a biomarker for atherogenic dyslipidemia in T2D.
Led by Jing-Yi Hu, Yang Xiao, and a team of metabolic health experts, the study enrolled 81 newly diagnosed T2D patients and 45 age- and sex-matched healthy controls. Atherogenic dyslipidemia was defined using National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria: TG ≥1.70 mmol/L, HDL-C <1.03 mmol/L (men) or <1.29 mmol/L (women), LDL-C ≥3.36 mmol/L, or current use of lipid-lowering drugs. Serum FGF19 levels were measured via enzyme-linked immunosorbent assay (ELISA), and participants underwent standard physical exams and blood tests for glucose, insulin, and lipid levels.
The results were striking: T2D patients with atherogenic dyslipidemia had significantly higher FGF19 levels (median: 301.2 pg/mL) compared to T2D patients without the condition (219.5 pg/mL) and healthy controls (228.4 pg/mL). Even after adjusting for age, sex, and body mass index (BMI), FGF19 remained strongly correlated with two key markers of poor lipid health: TG and LDL-C. A multiple linear regression analysis confirmed that these two lipids were the only independent predictors of FGF19 levels in T2D patients. Most importantly, the study found that higher FGF19 levels were associated with a 3-fold increased risk of atherogenic dyslipidemia in T2D—even after accounting for other risk factors like blood pressure and BMI.
FGF19 is best known for its role in signaling the liver to stop producing cholesterol and bile acids after a meal. In T2D patients with dyslipidemia, the researchers suspect elevated FGF19 may be a compensatory response: the body’s attempt to correct imbalanced lipid levels, though it’s not enough to reverse the damage. This makes FGF19 a unique marker—it reflects both the presence of harmful lipid changes and the body’s effort to fight them.
For T2D care, this is a critical step forward. If larger, long-term studies confirm these results, FGF19 could become a simple blood test to identify T2D patients at high risk of atherogenic dyslipidemia—before they develop life-threatening heart disease. Early detection would enable timely interventions: lifestyle changes (diet, exercise), medications (statins, fibrates), or other treatments to lower bad cholesterol and triglycerides, potentially saving lives.
The study has limitations: its small sample size and cross-sectional design mean it can’t prove FGF19 causes dyslipidemia—only that they’re linked. More research is needed to understand how FGF19 interacts with lipid metabolism in T2D and whether it can predict future cardiovascular events. But for now, the findings offer hope for a more proactive approach to T2D-related heart risk.
The research was published in the Chinese Medical Journal in 2021 by Jing-Yi Hu, Hai-Lan Zou, Yan-Hua Li, Dong-Ying Nie, Chen Chao, Jin-Han Liu, Jin Ding, Zhi-Guang Zhou, and Yang Xiao from the Second Xiangya Hospital, National Clinical Research Center for Metabolic Diseases, and Key Laboratory of Diabetes Immunology at Central South University in Changsha, China.
doi.org/10.1097/CM9.0000000000001574
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