Jamie Morton , MBBS 1 , 2 , Sophia Zoungas , PHD 3 , 4 , Qiang Li , MBIOSTAT 3 , Anushka A. Patel , PHD 3 , John Chalmers , PHD 3 , Mark Woodward , PHD 3 , David S. Celermajer , PHD 1 , 2 , 5 , Joline W.J. Beulens , PHD 6 , Ronald P. Stolk , PHD 6 , 7 , Paul Glasziou , PHD 8 , Martin K.C. Ng , PHD 1 , 2 , 5 , on behalf of the ADVANCE Collaborative Group
13 October 2012
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.
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.
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).