Low HDL cholesterol and the risk of diabetic nephropathy and retinopathy: Results of the advance study

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

*Corresponding author for this work

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Abstract

OBJECTIVE - Although low HDL cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and the risk ofmicrovascular disease are limited.We tested the association between HDL-C and microvascular disease in a cohort of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS - A total of 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazardsmodelswere used to assess the association between baselineHDL-C and the development of new or worsening microvascular disease, defined prospectively as a composite of renal and retinal events. RESULTS - The mean baseline HDL-C level was 1.3 mmol/L (SD 0.45mmol/L [range 0.1-4.0]). During follow-up, 32% of patients developed new or worsening microvascular disease, with 28% experiencing a renal event and 6%a retinal event. Compared with patients in the highest third, those in the lowest third had a 17% higher risk of microvascular disease (adjusted hazard ratio 1.17 [95% CI 1.06-1.28], P = 0.001) after adjustment for potential confounders and regression dilution. Thiswas driven by a 19%higher risk of renal events (1.19 [1.08-1.32], P = 0.0005). There was no association between thirds of HDL-C and retinal events (1.01 [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
Pages (from-to)2201-2206
Number of pages6
JournalDiabetes Care
Volume35
Issue number11
DOIs
Publication statusPublished - Nov 2012

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    Morton, J., Zoungas, S., Li, Q., Patel, A. A., Chalmers, J., Woodward, M., Celermajer, D. S., Beulens, J. W. J., Stolk, R. P., Glasziou, P., & Ng, M. K. C. (2012). Low HDL cholesterol and the risk of diabetic nephropathy and retinopathy: Results of the advance study. Diabetes Care, 35(11), 2201-2206. https://doi.org/10.2337/dc12-0306