Non-HDL Cholesterol as a Predictor of Cardiovascular Disease in Type 2 Diabetes

The Strong Heart Study

  1. Weiquan Lu, MD,
  2. Helaine E. Resnick, PHD,
  3. Kathleen A. Jablonski, PHD,
  4. Kristina L. Jones, MPH,
  5. Arvind K. Jain, MS,
  6. Wm. James Howard, MD,
  7. David C. Robbins, MD and
  8. Barbara V. Howard, PHD
  1. From the MedStar Research Institute and Washington Hospital Center, Washington, DC


    OBJECTIVE—To determine whether non-HDL cholesterol, a measure of total cholesterol minus HDL cholesterol, is a predictor of CVD in patients with diabetes.

    RESEARCH DESIGN AND METHODS—The Strong Heart Study, a population-based study of CVD and its risk factors in 13 American Indian communities in three geographic areas in the U.S. The baseline examination, conducted between July 1989 and January 1992, consisted of a personal interview, a physical examination, and laboratory tests. Of the 4,549 women and men aged 45−74 years participating in the study, 2,108 had diabetes but no CVD at baseline. Data on fatal and nonfatal CVD were collected during the follow-up period through 31 December 1998 (average 9 years).

    RESULTS—Multivariable analyses indicated that non-HDL cholesterol is a strong predictor of CVD in men and women with diabetes and is particularly indicative of coronary events. Hazard ratios for the highest tertile of non-HDL cholesterol in men and women with diabetes (2.23 and 1.80, respectively) were higher than those for either LDL cholesterol or triglycerides alone in both men and women and were higher than the ratio of total/HDL cholesterol in women. The utility of non-HDL cholesterol in predicting CVD extended over a wide range of triglyceride concentrations.

    CONCLUSIONS—This study suggests that non-HDL cholesterol index may be particularly useful in predicting CVD risk in patients with diabetes.


    • Address correspondence and reprint requests to Barbara V. Howard, PhD, President, MedStar Research Institute, 6495 New Hampshire Ave., Suite 201, Hyattsville, MD 20783. E-mail: barbara.v.howard{at}

      Received for publication 31 May 2002 and accepted in revised form 25 August 2002

      The views expressed in this paper are those of the authors and do not necessarily reflect those of the Indian Health Service.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

      See accompanying editorial on p. 240.

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