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

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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

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