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Wednesday, 1 June 2016

HDL Cholesterol as a Residual Risk Factor for Vascular Events and All-Cause Mortality in Patients With Type 2 Diabetes

Abstract

OBJECTIVE To evaluate whether low HDL cholesterol (HDL-c) levels are a risk factor for cardiovascular disease and mortality in patients with type 2 diabetes and whether it remains a residual risk factor when attaining low LDL cholesterol (LDL-c) treatment goals or when LDL-c is treated with intensive lipid-lowering therapy.

RESEARCH DESIGN AND METHODS
We performed a prospective cohort study of 1,829 patients with type 2 diabetes included in the Second Manifestations of ARTerial disease (SMART) cohort. Cox proportional hazard models were used to evaluate the risk of HDL-c on cardiovascular events and all-cause mortality. Analyses were performed in strata of LDL-c levels (<2.0, 2.0–2.5, and >2.5 mmol/L) and lipid-lowering therapy intensity and were adjusted for age, sex, BMI, smoking, alcohol, LDL-c, triglycerides, systolic blood pressure, estimated glomerular filtration rate, glucose, and HbA1c.

RESULTS A total of 335 new cardiovascular events and 385 deaths occurred during a median follow-up of 7.0 years (interquartile range 3.9–10.4). No relation was found between plasma HDL-c and cardiovascular events (hazard ratio [HR] 0.97, 95% CI 0.93–1.01) or all-cause mortality (HR 0.99, 95% CI 0.96–1.03). Subgroup analysis supported effect modification by plasma LDL-c levels. In patients with LDL-c levels <2.0 mmol/L, higher HDL-c was related to higher risk for all-cause mortality (HR 1.14, 95% CI 1.07–1.21). Higher HDL-c was also related to higher risk for cardiovascular events in patients with LDL-c levels <2.0 mmol/L (HR 1.10, 95% CI 1.07–1.21) in contrast to patients with LDL-c levels between 2.0 and 2.5 mmol/L (HR 0.85, 95% CI 0.75–0.95) and >2.5 mmol/L (HR 0.96, 95% CI 0.91–1.00).

CONCLUSIONS In high-risk patients with type 2 diabetes with LDL-c levels <2.0 mmol/L, higher HDL-c at baseline is unexpectedly related to a higher risk for cardiovascular events and all-cause mortality in contrast to high-risk patients with type 2 diabetes with LDL-c levels between 2.0 and 2.5 mmol/L.

http://care.diabetesjournals.org/

No matter how good your lipid profile is as diabetics the guidelines state LDL <2.0 mmol/L, so to attain that level statins are touted, as my HDL is always high thanks to LC according to his study following the prescribed cholesterol guidelines would put me and many others at a higher risk of CV

Graham

10 comments:

Missy George said...

Very informative thanks

Francisco Manuel Carrajola Oliveira said...

Um artigo muito interessante.
Continuação de uma boa semana.

Lowcarb team member said...

Hello Missy, many thanks for your comment.
Glad you found this article was informative.

All the best Jan

Lowcarb team member said...

Translation for Francisco's comment
Um artigo muito interessante. A very interesting article
Continuação de uma boa semana. Continuation of a good week

Hello Francisco, many thanks for your comment.
Olá Francisco, muito obrigado pelo seu comentário

All the best Jan

Bob Bushell said...

Cheese rolling, only at Gloucester.

Bob said...

Everyone who low carbs knows cholesterol is meaningless :)

Lowcarb team member said...

Hello Bob Bushell
It's always lovely to receive a comment from you thank you.
It refers to this post here
http://thelowcarbdiabetic.blogspot.co.uk/2016/06/cheese-rolling-fun-and-more.html

Hope your week is going well

All the best Jan

Lowcarb team member said...

Hello Bob
Many will agree with your comment here
"Everyone who low carbs knows cholesterol is meaningless :)"

All the best Jan

Lowcarb team member said...

Bob said...
Everyone who low carbs knows cholesterol is meaningless :)

Agreed Bob but as an aside given the dire warnings of the effects of saturated fats on LDL after eight years I'm still waiting for this to materialise mine is lower now than when I naively followed the low fat diet when first diagnosed

Go figure !!!!

Cheers

Graham

Anonymous said...

Hello Graham! Can I just clarify that in LCHF cholesterol levels are not important? In your research and reading is there any acceptable/desired levels to aim for with LDL and HDL? Am new to LCHF and am confused.com!