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Differential Association Between HDL Subclasses and the Development of Type 2 Diabetes in a Prospective Study of
You-Cheol Hwang1, Tomoshige Hayashi2, Wilfred Y Fujimoto3
1Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
Insights
Higher HDL2 cholesterol levels were linked to a reduced risk of developing type 2 diabetes. However, this association was influenced by visceral adipose tissue (VAT), suggesting it is not an independent predictor.
Area of Science:
- Endocrinology
- Metabolic Syndrome
- Cardiovascular Risk Factors
Background:
- High-density lipoprotein (HDL) cholesterol is linked to reduced type 2 diabetes risk.
- Specific HDL subclasses' roles in diabetes development remain unclear.
Purpose of the Study:
- To investigate the association between HDL subclasses (HDL2, HDL3) and incident type 2 diabetes.
- To determine if these associations are independent of other risk factors and visceral adipose tissue (VAT).
Main Methods:
- Longitudinal study of 406 Japanese Americans without diabetes.
- Assessed type 2 diabetes status via oral glucose tolerance tests over 10 years.
- Measured HDL2, HDL3, total HDL cholesterol, and VAT at baseline.
Main Results:
- Total HDL and HDL2 cholesterol inversely associated with diabetes incidence in univariate and multivariate analyses.
- HDL3 cholesterol showed no association with diabetes risk.
- Associations for total HDL and HDL2 cholesterol became non-significant after adjusting for VAT.
Conclusions:
- Higher HDL2 cholesterol is associated with lower type 2 diabetes risk, but this is confounded by VAT.
- HDL3 cholesterol is not associated with type 2 diabetes risk.
Objective:
Recent studies have suggested that HDL cholesterol is inversely associated with the development of type 2 diabetes. However, little is known about the association between different HDL subclasses and the risk for future type 2 diabetes.
Research Design And Methods:
The study enrolled 406 Japanese Americans (51% male) without diabetes, aged 34-75 years. Oral glucose tolerance tests were performed to determine type 2 diabetes status at baseline, 2.5 years, 5 years, and 10 years after enrollment. HDL2, HDL3, total HDL cholesterol, and visceral adipose tissue (VAT) area by computed tomography were measured at baseline.
Results:
In univariate analysis, total HDL and HDL2 cholesterol were inversely associated with the incidence of type 2 diabetes, but HDL3 cholesterol was not. In multivariate analysis, total HDL cholesterol (odds ratio per 1-SD increment, 0.72 [95% CI 0.52-0.995], P = 0.047) and HDL2 cholesterol (odds ratio per 1-SD increment, 0.64 [95% CI 0.44-0.93], P = 0.018) were inversely associated with the risk for type 2 diabetes independent of age, sex, BMI, waist circumference, family history of diabetes, lifestyle factors, systolic blood pressure, lipid-lowering medication use, triglyceride level, HOMA-insulin resistance, and 2-h glucose; however, HDL3 cholesterol was not associated with diabetes risk. The association between diabetes risk and total HDL and HDL2 cholesterol became insignificant after adjustment for VAT area.
Conclusions:
Subjects with higher HDL2 cholesterol were at lower risk for incident type 2 diabetes, but this association was confounded by and not independent of VAT. Higher HDL3 cholesterol was not associated with diabetes risk.
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