HDL Cholesterol and the Risk of Microvascular Disease of Type 2 Diabetes

Jamie Morton, Sophia Zoungas, Qiang Li, Anushka A. Patel, John Chalmers, Mark Woodward, David S. Celermajer, Joline W. Beulens, Ronald P. Stolk, Paul Glasziou, Martin K. Ng

Research output: Contribution to journalMeeting AbstractResearchpeer-review

Abstract

Although low HDL Cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and risk of microvascular disease are limited. We tested the association between HDL-C and microvascular disease in a large cohort of patients with type 2 diabetes. METHODS - 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazard models were used to assess the association between baseline HDL-C and development of new or worsening microvascular disease, defined prospectively as a composite of total renal events (new or worsening albuminuria, doubling of creatinine to >200umol/L, need for renal replacement therapy or renal related death) and total retinal events (new proliferative retinopathy, macular oedema, need for photocoagulation therapy or diabetes related blindness). RESULTS - The mean baseline HDL-C level was 1.3 mmol/L (SD 0.45 mmol/L, range 0.1-4.0 mmol/L). During follow-up, 32% of patients developed new or worsening microvascular disease with 28% experiencing a renal event and 6% a retinal event. Compared to patients in the highest third, those in the lowest third had a 17% higher risk of microvascular disease (adjusted HR=1.17, 95% CI 1.06-1.28, p=0.001) after adjustment for potential confounders and regression dilution. This was driven by a 19% higher risk of renal events (adjusted HR=1.19, 95% CI 1.08-1.32, p=0.0005). There was a similar significantly higher risk of developing new microalbuminuria and macroalbuminuria (adjusted HR 1.14, 95% CI 1.03-1.27, p=0.01 and 1.42, 95% CI 1.07-1.87, p=0.01 respectively). There was no association between thirds of HDL-C and retinal events (adjusted HR=1.01, 95% CI 0.82-1.25, p=0.9). CONCLUSIONS - In patients with type 2 diabetes HDL-C level is an independent risk factor for the development of microvascular disease affecting the kidney but not the retina.
Original languageEnglish
Article number12172
Number of pages1
JournalCirculation
Volume126
Issue number Suppl 21
Publication statusPublished - 20 Nov 2012

Cite this

Morton, J., Zoungas, S., Li, Q., Patel, A. A., Chalmers, J., Woodward, M., ... Ng, M. K. (2012). HDL Cholesterol and the Risk of Microvascular Disease of Type 2 Diabetes. Circulation, 126( Suppl 21), [12172].
Morton, Jamie ; Zoungas, Sophia ; Li, Qiang ; Patel, Anushka A. ; Chalmers, John ; Woodward, Mark ; Celermajer, David S. ; Beulens, Joline W. ; Stolk, Ronald P. ; Glasziou, Paul ; Ng, Martin K. / HDL Cholesterol and the Risk of Microvascular Disease of Type 2 Diabetes. In: Circulation. 2012 ; Vol. 126, No. Suppl 21.
@article{c4b698db464a4d5494a65a6e1c921fc8,
title = "HDL Cholesterol and the Risk of Microvascular Disease of Type 2 Diabetes",
abstract = "Although low HDL Cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and risk of microvascular disease are limited. We tested the association between HDL-C and microvascular disease in a large cohort of patients with type 2 diabetes. METHODS - 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazard models were used to assess the association between baseline HDL-C and development of new or worsening microvascular disease, defined prospectively as a composite of total renal events (new or worsening albuminuria, doubling of creatinine to >200umol/L, need for renal replacement therapy or renal related death) and total retinal events (new proliferative retinopathy, macular oedema, need for photocoagulation therapy or diabetes related blindness). RESULTS - The mean baseline HDL-C level was 1.3 mmol/L (SD 0.45 mmol/L, range 0.1-4.0 mmol/L). During follow-up, 32{\%} of patients developed new or worsening microvascular disease with 28{\%} experiencing a renal event and 6{\%} a retinal event. Compared to patients in the highest third, those in the lowest third had a 17{\%} higher risk of microvascular disease (adjusted HR=1.17, 95{\%} CI 1.06-1.28, p=0.001) after adjustment for potential confounders and regression dilution. This was driven by a 19{\%} higher risk of renal events (adjusted HR=1.19, 95{\%} CI 1.08-1.32, p=0.0005). There was a similar significantly higher risk of developing new microalbuminuria and macroalbuminuria (adjusted HR 1.14, 95{\%} CI 1.03-1.27, p=0.01 and 1.42, 95{\%} CI 1.07-1.87, p=0.01 respectively). There was no association between thirds of HDL-C and retinal events (adjusted HR=1.01, 95{\%} CI 0.82-1.25, p=0.9). CONCLUSIONS - In patients with type 2 diabetes HDL-C level is an independent risk factor for the development of microvascular disease affecting the kidney but not the retina.",
author = "Jamie Morton and Sophia Zoungas and Qiang Li and Patel, {Anushka A.} and John Chalmers and Mark Woodward and Celermajer, {David S.} and Beulens, {Joline W.} and Stolk, {Ronald P.} and Paul Glasziou and Ng, {Martin K.}",
year = "2012",
month = "11",
day = "20",
language = "English",
volume = "126",
journal = "Circulation",
issn = "0009-7322",
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Morton, J, Zoungas, S, Li, Q, Patel, AA, Chalmers, J, Woodward, M, Celermajer, DS, Beulens, JW, Stolk, RP, Glasziou, P & Ng, MK 2012, 'HDL Cholesterol and the Risk of Microvascular Disease of Type 2 Diabetes' Circulation, vol. 126, no. Suppl 21, 12172.

HDL Cholesterol and the Risk of Microvascular Disease of Type 2 Diabetes. / Morton, Jamie; Zoungas, Sophia; Li, Qiang; Patel, Anushka A.; Chalmers, John; Woodward, Mark; Celermajer, David S.; Beulens, Joline W.; Stolk, Ronald P.; Glasziou, Paul; Ng, Martin K.

In: Circulation, Vol. 126, No. Suppl 21, 12172, 20.11.2012.

Research output: Contribution to journalMeeting AbstractResearchpeer-review

TY - JOUR

T1 - HDL Cholesterol and the Risk of Microvascular Disease of Type 2 Diabetes

AU - Morton, Jamie

AU - Zoungas, Sophia

AU - Li, Qiang

AU - Patel, Anushka A.

AU - Chalmers, John

AU - Woodward, Mark

AU - Celermajer, David S.

AU - Beulens, Joline W.

AU - Stolk, Ronald P.

AU - Glasziou, Paul

AU - Ng, Martin K.

PY - 2012/11/20

Y1 - 2012/11/20

N2 - Although low HDL Cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and risk of microvascular disease are limited. We tested the association between HDL-C and microvascular disease in a large cohort of patients with type 2 diabetes. METHODS - 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazard models were used to assess the association between baseline HDL-C and development of new or worsening microvascular disease, defined prospectively as a composite of total renal events (new or worsening albuminuria, doubling of creatinine to >200umol/L, need for renal replacement therapy or renal related death) and total retinal events (new proliferative retinopathy, macular oedema, need for photocoagulation therapy or diabetes related blindness). RESULTS - The mean baseline HDL-C level was 1.3 mmol/L (SD 0.45 mmol/L, range 0.1-4.0 mmol/L). During follow-up, 32% of patients developed new or worsening microvascular disease with 28% experiencing a renal event and 6% a retinal event. Compared to patients in the highest third, those in the lowest third had a 17% higher risk of microvascular disease (adjusted HR=1.17, 95% CI 1.06-1.28, p=0.001) after adjustment for potential confounders and regression dilution. This was driven by a 19% higher risk of renal events (adjusted HR=1.19, 95% CI 1.08-1.32, p=0.0005). There was a similar significantly higher risk of developing new microalbuminuria and macroalbuminuria (adjusted HR 1.14, 95% CI 1.03-1.27, p=0.01 and 1.42, 95% CI 1.07-1.87, p=0.01 respectively). There was no association between thirds of HDL-C and retinal events (adjusted HR=1.01, 95% CI 0.82-1.25, p=0.9). CONCLUSIONS - In patients with type 2 diabetes HDL-C level is an independent risk factor for the development of microvascular disease affecting the kidney but not the retina.

AB - Although low HDL Cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and risk of microvascular disease are limited. We tested the association between HDL-C and microvascular disease in a large cohort of patients with type 2 diabetes. METHODS - 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazard models were used to assess the association between baseline HDL-C and development of new or worsening microvascular disease, defined prospectively as a composite of total renal events (new or worsening albuminuria, doubling of creatinine to >200umol/L, need for renal replacement therapy or renal related death) and total retinal events (new proliferative retinopathy, macular oedema, need for photocoagulation therapy or diabetes related blindness). RESULTS - The mean baseline HDL-C level was 1.3 mmol/L (SD 0.45 mmol/L, range 0.1-4.0 mmol/L). During follow-up, 32% of patients developed new or worsening microvascular disease with 28% experiencing a renal event and 6% a retinal event. Compared to patients in the highest third, those in the lowest third had a 17% higher risk of microvascular disease (adjusted HR=1.17, 95% CI 1.06-1.28, p=0.001) after adjustment for potential confounders and regression dilution. This was driven by a 19% higher risk of renal events (adjusted HR=1.19, 95% CI 1.08-1.32, p=0.0005). There was a similar significantly higher risk of developing new microalbuminuria and macroalbuminuria (adjusted HR 1.14, 95% CI 1.03-1.27, p=0.01 and 1.42, 95% CI 1.07-1.87, p=0.01 respectively). There was no association between thirds of HDL-C and retinal events (adjusted HR=1.01, 95% CI 0.82-1.25, p=0.9). CONCLUSIONS - In patients with type 2 diabetes HDL-C level is an independent risk factor for the development of microvascular disease affecting the kidney but not the retina.

M3 - Meeting Abstract

VL - 126

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - Suppl 21

M1 - 12172

ER -

Morton J, Zoungas S, Li Q, Patel AA, Chalmers J, Woodward M et al. HDL Cholesterol and the Risk of Microvascular Disease of Type 2 Diabetes. Circulation. 2012 Nov 20;126( Suppl 21). 12172.