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Importance of routine measurement of HDL with total cholesterol in diabetic patients
M D Feher1, J Stevens, A F Lant
1Department of Therapeutics, Charing Cross and Westminster Medical School, London.
Insights
Diabetic patients often have low HDL-cholesterol, a risk factor for heart disease. Measuring only total cholesterol misses many at-risk individuals, highlighting the need for comprehensive lipid profiling.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Disorders
Background:
- Hypercholesterolemia and reduced HDL-cholesterol are significant risk factors for macrovascular complications.
- Diabetes mellitus is associated with dyslipidemia, increasing cardiovascular risk.
Purpose of the Study:
- To evaluate the prevalence of hypercholesterolemia and reduced HDL-cholesterol in diabetic patients.
- To compare lipid profiles between diabetic and non-diabetic individuals.
- To assess the utility of total cholesterol measurement alone in identifying at-risk patients.
Main Methods:
- Cross-sectional study of 400 diabetic patients attending a diabetic clinic.
- Analysis of serum total cholesterol and HDL-cholesterol concentrations.
- Comparison with an age-matched group of 155 non-diabetic subjects.
Main Results:
- Over 25% of diabetic patients had total cholesterol > 6.5 mmol/l.
- Over 25% of non-insulin treated and 12.5% of insulin-treated diabetics had HDL-cholesterol < 0.9 mmol/l.
- Diabetic patients showed significantly higher rates of reduced HDL-cholesterol and elevated total/HDL-cholesterol ratios compared to non-diabetics.
Conclusions:
- Serum total cholesterol alone is insufficient to identify diabetic patients at risk of macrovascular complications due to low HDL-cholesterol.
- Comprehensive lipid profiling, including HDL-cholesterol, is crucial for risk assessment in diabetic populations.
- Male diabetic patients exhibited a higher prevalence of reduced HDL-cholesterol.
Abstract:
The prevalence of hypercholesterolaemia and the frequency of a reduced HDL-cholesterol (at different cholesterol concentrations) were evaluated in a group of 400 diabetic patients attending a single diabetic clinic. Despite regularly supervised diabetes, including dietary advice, over one quarter of the patients had a serum total cholesterol concentration greater than 6.5 mmol/l, while over a quarter of the non-insulin treated and one eighth of the insulin treated diabetic subjects had an HDL-cholesterol less than 0.9 mmol/l, with a greater prevalence in the males compared with the females. More than 60% of all the diabetic patients who had a reduced HDL-cholesterol less than 0.9 mmol/l also had a total cholesterol concentration less than 6.5 mmol/l. When the total/HDL-cholesterol ratio was calculated more non-insulin treated subjects had a value greater than 4.5 as compared with insulin treated diabetic patients. When comparisons were made between an age matched group of diabetic patients (n = 185) and a group of non-diabetic subjects attending for a health screen (n = 155), the frequencies of serum cholesterol concentrations greater than 5.2, 6.5, and 7.8 mmol/l were similar for both groups. Significantly greater numbers of diabetic patients had a reduced HDL-cholesterol less than 0.9 mmol/l (at any level of serum cholesterol) and a total/HDL cholesterol ratio greater than 4.5. This study has shown that the measurement of serum total cholesterol concentration alone will not characterize many subjects who are at risk of macrovascular complications due to a reduced HDL-cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS)