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Published on: October 12, 2017
Differences in HDL-related coronary heart disease risk between individuals with and without diabetes
Jun-Xiang Chen1, Qi Lu2, Tingting Geng3
1Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Public Health and Medical Technology, Xiamen Medical College, Xiamen, China.
Insights
High-density lipoprotein (HDL) cholesterol and particle levels impact coronary heart disease (CHD) risk differently in diabetics versus nondiabetics. Very high HDL cholesterol increases CHD risk in diabetics, while smaller HDL particles are also linked to higher risk.
Area of Science:
- Cardiovascular Disease Research
- Metabolic Syndrome Studies
- Lipoprotein Metabolism
Background:
- High-density lipoprotein (HDL) may lose its protective functions against atherosclerosis in diabetic individuals.
- Understanding the role of HDL cholesterol (HDL-C) and HDL particle (HDL-P) subclasses in coronary heart disease (CHD) risk is crucial, especially when stratified by diabetes status.
Purpose of the Study:
- To investigate the association between HDL-C and HDL-P subclasses and the risk of developing CHD.
- To stratify these associations based on the presence or absence of diabetes.
Main Methods:
- Utilized data from 393,516 participants in the UK Biobank, including 20,691 individuals with diabetes and 372,825 without.
- Employed restricted cubic splines with Cox proportional hazards models to analyze the associations between HDL measures and incident CHD over a median follow-up of 13.0 years.
Main Results:
- HDL-C showed inverse associations with CHD in nondiabetics but U-shaped associations in diabetics. Very high HDL-C was linked to lower CHD risk in nondiabetics but higher risk in diabetics.
- HDL-P associations varied: very large and large HDL-P showed inverted U-shaped and negative associations with CHD in nondiabetics, respectively. In contrast, diabetics exhibited positive associations with very large HDL-P and null associations with large HDL-P.
- Medium and small HDL-P demonstrated L-shaped associations with CHD in both diabetic and nondiabetic groups.
Conclusions:
- Very high HDL-C levels confer lower CHD risk in nondiabetics but increased risk in diabetics.
- In diabetics, smaller HDL particles are negatively associated with CHD risk, while very large HDL particles are positively associated.
- These findings enhance understanding of the complex interactions between HDL functionality and diabetes in the context of cardiovascular disease.
Background And Aims:
High-density lipoprotein (HDL) might lose atheroprotective functions in the presence of diabetes. We sought to examine associations of HDL cholesterol (HDL-C) and HDL particle (HDL-P) subclasses with risk of coronary heart disease (CHD) stratified by diabetes.
Methods:
We included 393,516 participants (20,691 diabetics and 372,825 nondiabetics) from the UK Biobank. Restricted cubic splines cooperated with Cox model were used to estimate associations of HDL with CHD.
Results:
During a median follow-up of 13.0 years, 3398 (16.4 %) and 24,772 (6.6 %) incident CHD events occurred among diabetics and nondiabetics, respectively. HDL-C showed inverse associations with CHD among nondiabetics, whereas U-shaped associations among diabetics. Compared to individuals with normal HDL-C (40th - 60th percentile, 1.32-1.51 mmol/L), those in the top percentile (95th, >2.16 mmol/L) had lower CHD risks among nondiabetics (Hazard Ratio, 0.79; 95 % confidence interval, 0.73-0.86), but higher risks among diabetics (1.38, 1.02-1.88). As for HDL-P, there were inverted U-shaped associations of very large HDL-P and linearly negative associations of large HDL-P with CHD among nondiabetics; however, linearly positive associations of very large HDL-P and null associations of large HDL were observed among diabetics. L-shaped associations of medium and small HDL-P were found both in diabetics and nondiabetics.
Conclusions:
Very high HDL-C levels were associated with lower CHD risks in nondiabetics, but higher risks in diabetics. Smaller HDL-P was negatively, whereas very large HDL-P was positively associated with CHD risk in diabetics. These data advance our knowledge about the interactions between HDL and diabetes.
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