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Higher Levels of HDL Cholesterol Are Associated With a Decreased Likelihood of Albuminuria in Patients With Long-Standing Type 1 Diabetes

¹ Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
² Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Address correspondence and reprint requests to Mark E. Molitch, MD, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave. (Tarry 15-731), Chicago, IL 60611. E-mail: molitch{at}northwestern.edu

OBJECTIVE—The objective of this study was to determine whether high levels of HDL cholesterol are associated with a lower prevalence of albuminuria

RESEARCH DESIGN AND METHODS—We analyzed the lipid profiles of patients with type 1 diabetes of 20 years duration in 42 patients with albuminuria (28 microalbuminuria and 14 macroalbuminuria) and 65 patients without increased albumin excretion before any interventions with either statins or ACE inhibitors.

RESULTS—Several characteristics were similar in the two groups: sex, age, duration of diabetes, total cholesterol, LDL cholesterol, and triglycerides. By univariate analysis, significant differences (P < 0.01) were found in HDL cholesterol (albuminuria 1.42 mg/dl, no albuminuria 1.71 mg/dl, P < 0.01), HbA_1c (A1C) (albuminuria 8.5%, no albuminuria 7.5%), and proportions with no, background, and proliferative retinopathy (albuminuria 2.4, 16.7, and 81%; no albuminuria 24.6, 52.3, and 23.1%, respectively). When adjusted for age and sex, a 0.26-mmol/l (10-mg/dl) increase in HDL cholesterol is associated with an odds ratio (OR) of 0.70 (95% CI 0.54–0.90) for having albuminuria. In a multivariate model that adjusted for age, sex, diabetes duration, and A1C, for every 0.54-mmol/l (21-mg/dl) increase in HDL cholesterol, patients are approximately half (OR 0.51 [95% CI 0.30–0.86]) as likely to have albuminuria, even after controlling for A1C.

CONCLUSIONS—Higher HDL cholesterol levels may be protective against the development of albuminuria in patients with type 1 diabetes. Whether this is due to the HDL cholesterol levels or whether they serve as a marker for some other mechanism remains to be determined.

Abbreviations: GFR, glomerular filtration rates • NHANES, National Health and Nutrition Examination Survey

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