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High-density lipoprotein cholesterol in diabetes: is higher always better?

Tina Costacou1, Rhobert W Evans, Trevor J Orchard

  • 1Department of Epidemiology, University of Pittsburgh, PA 15213, USA. CostacouT@edc.pitt.edu

Journal of Clinical Lipidology
|October 11, 2011
PubMed

Insights

In type 1 diabetes, high HDL-C may increase cardiovascular disease risk in women, unlike men. HDL3 cholesterol is linked to coronary artery disease in both genders.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Diseases

Background:

  • Elevated high-density lipoprotein cholesterol (HDL-C) may not always confer cardiovascular protection.
  • Cardiovascular disease (CVD) risk is elevated in type 1 diabetes (T1D) despite higher mean HDL-C levels.
  • The relationship between HDL-C, its subfractions, and CVD in T1D requires further investigation.

Purpose of the Study:

  • To examine the association between HDL-C, HDL3 cholesterol, and coronary artery disease (CAD) in individuals with childhood-onset T1D.
  • To determine if gender influences the relationship between HDL-C levels and CAD risk in T1D.

Main Methods:

  • Longitudinal study of 301 men and 298 women with T1D, free of CAD at baseline.
  • CAD defined by clinical events, ECG changes, myocardial infarction, or angiographic stenosis.
  • HDL-C and HDL3 cholesterol measured enzymatically.

Main Results:

  • Over 18 years, 29.5% of men and 25.5% of women developed CAD.
  • In men, HDL-C showed a linear inverse association with CAD risk after adjustment.
  • In women, a U-shaped relationship was observed for HDL-C and CAD risk, with increased risk at very low (<47 mg/dL) and very high (>80 mg/dL) levels.
  • HDL3 cholesterol was significantly associated with CAD risk in both men and women.

Conclusions:

  • Increased CAD risk associated with very high HDL-C (>80 mg/dL) in women with T1D warrants further research.
  • Gender-specific patterns in HDL-C and CAD risk may exist in T1D.
  • HDL3 cholesterol is a potential biomarker for CAD risk in T1D.
Abstract

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