Low HDL Cholesterol and the Risk of Diabetic Nephropathy and Retinopathy
Results of the ADVANCE study
- Jamie Morton, MBBS1,2,
- Sophia Zoungas, PHD3,4⇓,
- Qiang Li, MBIOSTAT3,
- Anushka A. Patel, PHD3,
- John Chalmers, PHD3,
- Mark Woodward, PHD3,
- David S. Celermajer, PHD1,2,5,
- Joline W.J. Beulens, PHD6,
- Ronald P. Stolk, PHD6,7,
- Paul Glasziou, PHD8,
- Martin K.C. Ng, PHD1,2,5⇓ and
- on behalf of the ADVANCE Collaborative Group
- 1The Heart Research Institute, Sydney, New South Wales, Australia
- 2Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- 3The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
- 4School of Public Health, Monash University, Melbourne, Victoria, Australia
- 5Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- 6Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
- 7Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
- 8Department of Clinical Epidemiology and Biostatistics, Bond University, Gold Coast, Queensland, Australia
- Corresponding authors: Sophia Zoungas, ; and Martin K.C. Ng, .
OBJECTIVE Although low HDL cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and the risk of microvascular disease are limited. We tested the association between HDL-C and microvascular disease in a cohort of patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS A total of 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazards models were used to assess the association between baseline HDL-C and the development of new or worsening microvascular disease, defined prospectively as a composite of renal and retinal events.
RESULTS The mean baseline HDL-C level was 1.3 mmol/L (SD 0.45 mmol/L [range 0.1–4.0]). During follow-up, 32% of patients developed new or worsening microvascular disease, with 28% experiencing a renal event and 6% a retinal event. Compared with patients in the highest third, those in the lowest third had a 17% higher risk of microvascular disease (adjusted hazard ratio 1.17 [95% CI 1.06–1.28], P = 0.001) after adjustment for potential confounders and regression dilution. This was driven by a 19% higher risk of renal events (1.19 [1.08–1.32], P = 0.0005). There was no association between thirds of HDL-C and retinal events (1.01 [0.82–1.25], P = 0.9).
CONCLUSIONS In patients with type 2 diabetes, HDL-C level is an independent risk factor for the development of microvascular disease affecting the kidney but not the retina.
- Received February 12, 2012.
- Accepted May 2, 2012.
- © 2012 by the American Diabetes Association.
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