HDL Cholesterol as a Residual Risk Factor for Vascular Events and All-Cause Mortality in Patients With Type 2 Diabetes

Abstract

OBJECTIVE To evaluate whether low HDL cholesterol (HDL-c) levels are a risk factor for cardiovascular disease and mortality in patients with type 2 diabetes and whether it remains a residual risk factor when attaining low LDL cholesterol (LDL-c) treatment goals or when LDL-c is treated with intensive lipid-lowering therapy.

RESEARCH DESIGN AND METHODS We performed a prospective cohort study of 1,829 patients with type 2 diabetes included in the Second Manifestations of ARTerial disease (SMART) cohort. Cox proportional hazard models were used to evaluate the risk of HDL-c on cardiovascular events and all-cause mortality. Analyses were performed in strata of LDL-c levels (<2.0, 2.0–2.5, and >2.5 mmol/L) and lipid-lowering therapy intensity and were adjusted for age, sex, BMI, smoking, alcohol, LDL-c, triglycerides, systolic blood pressure, estimated glomerular filtration rate, glucose, and HbA1c.

RESULTS A total of 335 new cardiovascular events and 385 deaths occurred during a median follow-up of 7.0 years (interquartile range 3.9–10.4). No relation was found between plasma HDL-c and cardiovascular events (hazard ratio

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0.97, 95% CI 0.93–1.01) or all-cause mortality (HR 0.99, 95% CI 0.96–1.03). Subgroup analysis supported effect modification by plasma LDL-c levels. In patients with LDL-c levels <2.0 mmol/L, higher HDL-c was related to higher risk for all-cause mortality (HR 1.14, 95% CI 1.07–1.21). Higher HDL-c was also related to higher risk for cardiovascular events in patients with LDL-c levels <2.0 mmol/L (HR 1.10, 95% CI 1.07–1.21) in contrast to patients with LDL-c levels between 2.0 and 2.5 mmol/L (HR 0.85, 95% CI 0.75–0.95) and >2.5 mmol/L (HR 0.96, 95% CI 0.91–1.00).

CONCLUSIONS In high-risk patients with type 2 diabetes with LDL-c levels <2.0 mmol/L, higher HDL-c at baseline is unexpectedly related to a higher risk for cardiovascular events and all-cause mortality in contrast to high-risk patients with type 2 diabetes with LDL-c levels between 2.0 and 2.5 mmol/L.

http://care.diabetesjournals.org/content/early/2016/05/14/dc16-0155

Derek wrote:Hi,
You may be interested in a conclusion of Malcolm Kendick in section 12 of his paper on what causes CVD.

So, ahem yes, blood borne lipoproteins do have a role to play in CVD. The role is not key, but it is there. I thought I should get that off my chest.   But one should real the whole paper.
Derek

Derek wrote:Sorry I should have shown the quote.
He seems to be back peddling on Cholesterol!

Derek wrote:The very ancient pathologist Dr. Kraft claimed,and he would know cos he took people apart.  That hyperinsulineamia causes most CVD.
D.

graham64 wrote:Thomas Dayspring aka Dr Lipid

200 mg/dl  = 5.172 mmol/l

Derek wrote:Hi Graham,
What do you make of this report, please?    http://dx.doi.org/10.2337/dc15-2450  It was done on T1D's
Derek

chris c wrote:Strange, my LDL initially went up on low carb, then came down again when I added more saturated fats. This sometimes happens during weight loss - I had 15kg to lose thanks to that damn dietician.

Even more strange, and shows the interraction of the endocrine system, while I was hypERthyroid my LDL dropped exactly as much as a statin caused, then went up again as I went HypOthyroid - it was overtreated.