Effect of niacin on preβ-1 high-density lipoprotein levels in diabetes

Preβ-1 high-density lipoprotein (HDL) is an acceptor of peripheral free cholesterol and thus a participant in reverse cholesterol transport. Because patients with diabetes may have defects in reverse cholesterol transport, we hypothesized that (1) preβ-1 HDL might be decreased in diabetes and (2) because niacin improves reverse cholesterol transport and may stimulate preβ-1 HDL maturation, niacin would further decrease steady-state levels of preβ-1 HDL in diabetes. Absolute levels of preβ-1 HDL mass were measured using an isotopic dilution-ultrafiltration assay that measures apolipoprotein (apo) A-I after physically isolating preβ-1. Plasma apo A-I concentration and routine lipids were also evaluated in 11 diabetic patients. Diabetic subjects have a nearly 50% reduction of circulating levels of preβ-1 HDL to 36 ± 22 (1 SD) μg/mL compared with our previously published values of 73 ± 44 μg/mL in 136 healthy subjects. After niacin therapy, there was a further 17% reduction of preβ-1 HDL levels to 30 ± 26 μg/mL (P < .026) compared with baseline. The percentage of preβ-1 HDL in diabetic patients, as a percentage of total apo A-I, was about half of the normal value of 6.1% ± 3.6%; after niacin in diabetic patients, the percentage further decreased from 3.3% ± 2.1% to 2.3% ± 1.9% (P < .003). Absolute levels of apo A-I were similar in diabetic patients (1.14 ± 0.29) and healthy subjects (1.24 ± 0.24), and were unchanged by niacin in diabetic patients. We conclude with the novel observations that diabetes is associated with significantly reduced levels of preβ-1 HDL and that, after niacin treatment, a further lowering of preβ-1 HDL levels occur. Several altered mechanisms of RCT in diabetes are consistent with low levels of preβ-1 HDL both before and after niacin treatment.