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

Abstract

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 HeartStudy, 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 45Ϫ74 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. Diabetes Care 26:16 -23, 2003C ardiovascular disease (CVD) is currently the primary cause of morbidity and mortality in patients with diabetes (1-4). Because individuals with diabetes have greatly increased CVD risk compared with nondiabetic individuals (5-9), it is important to identify factors that may increase CVD risk in diabetic patients.In type 2 diabetes, there is a characteristic dyslipidemia consisting of elevated triglycerides, decreased HDL cholesterol, and LDL particles of altered composition (10 -12). Previous studies (5-9,13-15) indicate that, in addition to LDL cholesterol level, this dyslipidemia is an important CVD risk factor in individuals with diabetes. Although the CVD risk associated with individual lipoproteins has been examined, it would be valuable to have a measure that reflects the combined risk of all lipoprotein changes observed in diabetes. Some investigators (16 -18) have recently suggested that a measure of non-HDL cholesterol, which reflects total cholesterol minus HDL cholesterol (i.e., all apolipoprotein Bcontaining atherogenic lipoproteins), might be a useful marker of this combined risk. A recent study conducted in a cohort containing both diabetic and nondiabetic individuals showed that non-HDL cholesterol was a somewhat better predictor of CVD than LDL cholesterol (19). Furthermore, the Adult Treatment Panel (ATP-III) of the National Cholesterol Education Program has recommended using non-HDL cholesterol in assessing CVD risk in patients with diabetes (20). However, there have been no populationbased studies evaluating the utility of non-HDL cholesterol as a predictor of...

Elevated Non-high-density Lipoprotein Cholesterol (Non-HDL-C) Predicts Atherosclerotic Cardiovascular Events in Hemodialysis Patients

“…This may not be surprising, because non-HDL-C is the sum of cholesterol in LDL and TG-rich lipoproteins, and both LDL and TGrich lipoproteins are independently associated with atherosclerotic arterial changes in dialysis patients (23). The better prediction by non-HDL-C than LDL-C was also reported for the general population (37) and in the cohort including type 2 diabetes patients (38,39). Non-HDL-C level is an integrated index for atherogenic lipoproteins, and it is not affected by eating (40).…”

Effect of age on the association of non-high-density-lipoprotein cholesterol and apolipoprotein B with cardiovascular mortality in a Mediterranean population with type 2 diabetes: the Casale Monferrato study

“…The Strong Heart Study, which addressed only American Indians, showed that non-HDL-cholesterol is a better predictor of cardiovascular morbidity than LDL-cholesterol [17]. Two further studies of people with diabetes in the USA, who were free of cardiovascular disease at baseline, comprised 921 female nurses aged <65 years [18] and 746 male health professionals aged 46-81 years [19].…”

“…Since that time, a substantial number of reports have indicated that ApoB and non-HDL-cholesterol are better predictors than LDL-cholesterol in people with diabetes [16][17][18][19]. Few studies have been conducted, however, to compare non-HDL-cholesterol with ApoB [18,19]; the studies that have been reported were restricted to North America, and the results were mixed.…”

Dyslipidemia and Diabetes: Reciprocal Impact of Impaired Lipid Metabolism and Beta-Cell Dysfunction on Micro- and Macrovascular Complications

“…It is an important measure of these particles in the presence of high triglyceride levels. The use of non-HDL-C has been demonstrated to be a better predictor of CVD events than LDL-C alone, particularly in patients with insulin resistance and/or diabetes [38,39]. For this reason, it is recommended that non-HDL-C should act as secondary target of therapy after targeting LDL-C levels in patients with increased Trg (>200 mg/dl), because the LDL-C level calculated by the Friedewald formula cannot be applied in the presence of hypertriglyceridemia [40].…”