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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #404438
Research Project: Diet and Cardiovascular Health

Location: Jean Mayer Human Nutrition Research Center On Aging

Title: Different associations between HDL cholesterol and cardiovascular diseases in people with diabetes mellitus and people without diabetes mellitus: a prospective community-based study

Author
item WU, ZHIJUN - Shanghai Jiaotong University
item HUANG, ZHE - Kailuan Hospital
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item JIN, CHENG - Kailuan Hospital
item CHEN, SHUOHUA - Kailuan Hospital
item WU, SHOULING - Kailuan Hospital
item GAO, XIANG - Pennsylvania State University

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/21/2021
Publication Date: 9/1/2021
Citation: Wu, Z., Huang, Z., Lichtenstein, A.H., Jin, C., Chen, S., Wu, S., Gao, X. 2021. Different associations between HDL cholesterol and cardiovascular diseases in people with diabetes mellitus and people without diabetes mellitus: a prospective community-based study. The American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqab163.
DOI: https://doi.org/10.1093/ajcn/nqab163

Interpretive Summary: Higher HDL cholesterol concentrations have been associated with lower cardiovascular disease (CVD) risk in multiple cohorts. Some data suggests the protective effect of HDL-cholesterol may be lost in the presence of diabetes mellitus (DM). The aim of this study was to determine whether DM modified the association between HDL-cholesterol concentrations and CVDin a cohort of 91,354 Chinese adults. The findings indicated that those with moderate HDL-cholesterol concentrations were at lowest risk. In participants with DM, higher HDL-cholesterol concentrations were associated with higher risk of CVD, indicating that the benefits in terms of HDL cholesterol concentrations and CVD risk were lost. Hence, the findings indicate that in the cohort studied, higher HDL-cholesterol concentrations were paradoxically associated with higher CVD risk in individuals with or without DM. In individuals with DM, low HDL-cholesterol concentrations failed to predict future CVD risk.

Technical Abstract: Background: Experimental studies have found that the functionality of HDL cholesterol may be lost in the presence of diabetes mellitus (DM). Objectives: We aimed to elucidate whether DM modified the association between HDL-cholesterol concentrations and cardiovascular disease (CVD) outcomes. Methods: Included were 91,354 Chinese adults (8244 participants with DM and 83,110 participants without DM) free of CVD or cancer at baseline (2006) and without use of lipid-lowering drugs at baseline and during follow-up. The primary endpoint of interest was a composite of CVDs (myocardial infarction, ischemic stroke, and hemorrhagic stroke). Cumulative average HDL-cholesterol concentrations were calculated from all available HDL-cholesterol measures at baseline (2006) and during the follow-up period (2008, 2010, 2012, and 2014). Results: During a mean of 10.4 y of follow-up, there were 5076 CVD events identified. There was a significant interaction between DM and HDL-cholesterol concentrations on CVD risk (P interaction = 0.003). The association between HDL-cholesterol concentrations and CVD followed a U-shaped curve in individuals without DM (P nonlinearity < 0.001). The adjusted HR of CVD was 1.26 (95% CI: 1.07, 1.48) for HDL-cholesterol concentrations < 1.04 mmol/L and 1.76 (95% CI: 1.53, 2.03) for HDL-cholesterol concentrations > 2.07 mmol/L, relative to the lowest risk group (HDL-cholesterol concentrations of 1.30-1.42 mmol/L). In participants with DM, higher HDL-cholesterol concentrations were associated with a higher risk of CVD, in a dose-response manner (P nonlinearity = 0.44; Ptrend < 0.001). The adjusted HR of CVD was 1.62 (95% CI: 1.19, 2.20) for HDL-cholesterol concentrations >2.07 mmol/L, relative to HDL-cholesterol concentrations of 1.30-1.42 mmol/L. Conclusions: High HDL-cholesterol concentrations were paradoxically associated with high risk of composite CVD outcomes in individuals with or without DM. However, low HDL-cholesterol concentrations failed to predict future CVD risk in individuals with DM.