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Published on: October 12, 2017
High-density lipoprotein subclasses and cardiovascular disease and mortality in type 2 diabetes: analysis from the
Qiao Jin1, Eric S H Lau1,2, Andrea O Luk1,2,3
1Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China.
Insights
Small high-density lipoprotein particles (HDL-P) are linked to lower cardiovascular disease (CVD) and mortality risk in type 2 diabetes (T2D). These HDL-P improve risk prediction for adverse outcomes in T2D patients.
Area of Science:
- Cardiovascular Medicine
- Metabolic Disorders
- Lipidology
Background:
- High-density lipoproteins (HDL) have varying vasoprotective functions based on particle size, density, and composition.
- Diabetes mellitus significantly alters HDL composition and function, potentially impacting cardiovascular risk.
Purpose of the Study:
- To investigate the association of HDL size-based subclasses with incident cardiovascular disease (CVD) and mortality in individuals with type 2 diabetes (T2D).
- To evaluate the prognostic utility of HDL subclasses in predicting adverse cardiovascular outcomes and mortality in the T2D population.
Main Methods:
- Nuclear magnetic resonance spectroscopy was used to determine HDL subclasses (small, medium, large, very large) in sera from 1991 adults with T2D.
- Multivariate Cox proportional hazards models assessed associations between HDL subclasses and incident CVD/mortality.
- Predictive value was evaluated using C-statistic, integrated discrimination index (IDI), and net reclassification improvement (NRI).
Main Results:
- Small HDL particles (HDL-P) were inversely associated with incident CVD (HR 0.65) and all-cause mortality (HR 0.47).
- Very large HDL-P showed a positive association with all-cause mortality (HR 1.75).
- Small HDL-P significantly improved the prediction of mortality and CVD events, enhancing risk stratification beyond existing models.
Conclusions:
- Small HDL-P are inversely associated with incident CVD and all-cause mortality in individuals with T2D.
- HDL subclasses, particularly small HDL-P, can serve as valuable markers for residual cardiovascular risk assessment in T2D patients.
- These findings highlight the importance of HDL particle size in cardiovascular risk stratification for diabetic populations.
Objective:
High-density lipoproteins (HDL) comprise particles of different size, density and composition and their vasoprotective functions may differ. Diabetes modifies the composition and function of HDL. We assessed associations of HDL size-based subclasses with incident cardiovascular disease (CVD) and mortality and their prognostic utility.
Research Design And Methods:
HDL subclasses by nuclear magnetic resonance spectroscopy were determined in sera from 1991 fasted adults with type 2 diabetes (T2D) consecutively recruited from March 2014 to February 2015 in Hong Kong. HDL was divided into small, medium, large and very large subclasses. Associations (per SD increment) with outcomes were evaluated using multivariate Cox proportional hazards models. C-statistic, integrated discrimination index (IDI), and categorial and continuous net reclassification improvement (NRI) were used to assess predictive value.
Results:
Over median (IQR) 5.2 (5.0-5.4) years, 125 participants developed incident CVD and 90 participants died. Small HDL particles (HDL-P) were inversely associated with incident CVD [hazard ratio (HR) 0.65 (95% CI 0.52, 0.81)] and all-cause mortality [0.47 (0.38, 0.59)] (false discovery rate < 0.05). Very large HDL-P were positively associated with all-cause mortality [1.75 (1.19, 2.58)]. Small HDL-P improved prediction of mortality [C-statistic 0.034 (0.013, 0.055), IDI 0.052 (0.014, 0.103), categorical NRI 0.156 (0.006, 0.252), and continuous NRI 0.571 (0.246, 0.851)] and CVD [IDI 0.017 (0.003, 0.038) and continuous NRI 0.282 (0.088, 0.486)] over the RECODe model.
Conclusion:
Small HDL-P were inversely associated with incident CVD and all-cause mortality and improved risk stratification for adverse outcomes in people with T2D. HDL-P may be used as markers for residual risk in people with T2D.
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