Is HDL cholesterol protective in patients with T2D?

  • Fanni G & al.
  • J Transl Med
  • 6 May 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Among patients with type 2 diabetes (T2D), high-density lipoprotein cholesterol (HDL) was not significantly associated with overall, cardiovascular, or cancer mortality.
  • The results did show a significant U-shaped association with infectious disease mortality.

Why this matters

  • The protective role of high HDL against cardiovascular disease (CVD) has been recently questioned, but limited data address its benefit or not in T2D.

Study design

  • Retrospective population-based cohort study, 2113 patients with T2D attending an Italian diabetes clinic.
  • Patients grouped by HDL tertiles, with middle used as reference.
  • Funding: None.

Key results

  • HDL tertile cut-offs were 37.5 mg/dL and 47.5 mg/dL for males and 41.5 mg/dL and 52.0 mg/dL for females.
  • During the 14-year follow-up, 46.1% (973) died.
  • Lower vs upper HDL tertiles did not differ (adjusted HRs; 95% CIs) in mortality from:
    • All-causes: 1.12 (0.96-1.32) vs 1.11 (0.95-1.30).
    • CVD: 0.97 (0.77-1.23) vs 0.94 (0.75-1.18). 
    • Cancer: 0.92 (0.67-1.25) vs 0.89 (0.66-1.21).
  • Vs middle tertile, infectious disease mortality (adjusted HRs, 95% CIs) was significantly increased in: 
    • Low tertile: 2.62 (1.44-4.74).
    • High tertile: 2.05 (1.09-3.85
  • Increased risk for diabetes-related mortality in upper HDL tertile: 
    • Adjusted HR, 1.87 (95% CI, 1.10-3.15).
  • Exclusion of 646 with baseline CVD did not significantly alter results.

Limitations

  • No data on inflammatory status, specific infectious diseases.
  • Only baseline values collected.
  • Possible residual confounding.