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Non-HDL Cholesterol and Apolipoprotein B Predict Cardiovascular Disease Events Among Men With Type 2 Diabetes

¹ Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
² Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
³ Department of Medicine, Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
⁴ Department of Laboratory Medicine, Children’s Hospital and Harvard Medical School, Boston, Massachusetts

Address correspondence and reprint requests to Rui Jiang, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115. E-mail: rjiang{at}hsph.harvard.edu

OBJECTIVE—To evaluate the role of non-HDL cholesterol and apolipoprotein (apo)B, markers of all potentially atherogenic lipoproteins, as predictors of cardiovascular disease (CVD) in comparison with LDL cholesterol in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS—We prospectively followed 746 diabetic men in the Health Professionals’ Follow-up Study who were aged 46–81 years and free of CVD or cancer at the time of blood draw in 1993–1994. During 6 years of follow-up, we ascertained 103 incident CVD cases.

RESULTS—We used Cox proportional hazard modeling to estimate the relative risk (RR) of CVD. After adjustment for age, BMI, and other lifestyle risk factors, the multivariate RR of CVD (the highest versus the lowest quartile) was 2.34 (95% CI 1.26–4.32) for non-HDL cholesterol, 2.31 (1.23–4.35) for apoB, and 1.74 (0.99–3.06) for LDL cholesterol. Comparisons of nested models indicate that non-HDL cholesterol, but not apoB, adds significantly to the prediction of CVD risk beyond LDL cholesterol. The area under the receiver operating characteristic curve was 0.685, 0.691, 0.695, and 0.722 for the CVD risk-prediction model with LDL cholesterol, apoB, non-HDL cholesterol, and total cholesterol–to–HDL cholesterol ratio (or the non-HDL–to–HDL cholesterol ratio), respectively.

CONCLUSIONS—Non-HDL cholesterol and apoB are more potent predictors of CVD incidence among diabetic men than LDL cholesterol. Statistically, the ratio of total to HDL cholesterol is the best predictor of CVD in this cohort of diabetic men.

Abbreviations: apo, apolipoprotein • CHD, coronary heart disease • CVD, cardiovascular disease • IDL, intermediate-density lipoprotein • ROC, receiver-operating characteristic • VLDL, very-low-density lipoprotein

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