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, ADVANCE Collaborative Grp

*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 of microvascular 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 hazards models were used to assess the association between baseline HDL-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. This was 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. Diabetes Care 35: 2201-2206, 2012

Original languageEnglish
Pages (from-to)2201-2206
Number of pages6
JournalDiabetes Care
Volume35
Issue number11
DOIs
Publication statusPublished - Nov-2012

Keywords

  • RANDOMIZED CONTROLLED-TRIAL
  • ATHEROSCLEROSIS RISK
  • BLOOD-PRESSURE
  • RENAL DYSFUNCTION
  • PLASMA-LIPIDS
  • MELLITUS
  • PROGRESSION
  • DISEASE
  • COMMUNITIES
  • MICROALBUMINURIA

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