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 - 2012/11/1
Y1 - 2012/11/1
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.
UR - http://www.scopus.com/inward/record.url?scp=84868090154&partnerID=8YFLogxK
U2 - 10.2337/dc12-0306
DO - 10.2337/dc12-0306
M3 - Article
C2 - 22891258
AN - SCOPUS:84868090154
VL - 35
SP - 2201
EP - 2206
JO - Diabetes Care
JF - Diabetes Care
SN - 0149-5992
IS - 11
ER -