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

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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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Diabetic Nephropathies
Diabetic Retinopathy
HDL Cholesterol
Type 2 Diabetes Mellitus
Kidney
Kidney Diseases
Retina
Atherosclerosis
Research Design

Cite this

Morton, J., Zoungas, S., Li, Q., Patel, A. A., Chalmers, J., Woodward, M., ... 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
Morton, Jamie ; Zoungas, Sophia ; Li, Qiang ; Patel, Anushka A. ; Chalmers, John ; Woodward, Mark ; Celermajer, David S. ; Beulens, Joline W J ; Stolk, Ronald P. ; Glasziou, Paul ; Ng, Martin K C. / Low HDL cholesterol and the risk of diabetic nephropathy and retinopathy : Results of the advance study. In: Diabetes Care. 2012 ; Vol. 35, No. 11. pp. 2201-2206.
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title = "Low HDL cholesterol and the risk of diabetic nephropathy and retinopathy: Results of the advance study",
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.",
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 J} and Stolk, {Ronald P.} and Paul Glasziou and Ng, {Martin K C}",
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Morton, J, Zoungas, S, Li, Q, Patel, AA, Chalmers, J, Woodward, M, Celermajer, DS, Beulens, JWJ, Stolk, RP, Glasziou, P & Ng, MKC 2012, 'Low HDL cholesterol and the risk of diabetic nephropathy and retinopathy: Results of the advance study' Diabetes Care, vol. 35, no. 11, pp. 2201-2206. https://doi.org/10.2337/dc12-0306

Low HDL cholesterol and the risk of diabetic nephropathy and retinopathy : Results of the advance study. / Morton, Jamie; Zoungas, Sophia; Li, Qiang; Patel, Anushka A.; Chalmers, John; Woodward, Mark; Celermajer, David S.; Beulens, Joline W J; Stolk, Ronald P.; Glasziou, Paul; Ng, Martin K C.

In: Diabetes Care, Vol. 35, No. 11, 11.2012, p. 2201-2206.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Low HDL cholesterol and the risk of diabetic nephropathy and retinopathy

T2 - Results of the advance study

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 J

AU - Stolk, Ronald P.

AU - Glasziou, Paul

AU - Ng, Martin K C

PY - 2012/11

Y1 - 2012/11

N2 - 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.

AB - 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.

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U2 - 10.2337/dc12-0306

DO - 10.2337/dc12-0306

M3 - Article

VL - 35

SP - 2201

EP - 2206

JO - Diabetes Reviews

JF - Diabetes Reviews

SN - 0149-5992

IS - 11

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