Low HDL cholesterol ADVANCEs nephropathy risk in diabetes

By Sally Robertson, B.Sc.Aug 15 2012

People with diabetes are at a greater risk for the development or progression of diabetic nephropathy if they have low levels of high-density lipoprotein (HDL) cholesterol, report researchers.

In a large population of patients with diabetes, individuals with low HDL cholesterol were found to be almost 20% more likely to develop the condition than those with high levels.

"Measurement of this lipid fraction may be useful in tailoring screening and therapeutic strategies," write Sophia Zoungas (University of Sydney, New South Wales, Australia) and team.

The findings come from the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) Study, which included 11,140 patients with diabetes and at least one other cardiovascular factor who were followed up for the development of microvascular complications.

"This study is the largest prospective analysis specifically addressing HDL-C [cholesterol] level and risk of microvascular disease in patients with Type 2 diabetes," say Zoungas and team.

The researchers report that, over a median 5-year follow-up period, 3585 (32%) of the trial participants developed new or worsening microvascular disease, with 28% experiencing a renal event and 6% a retinal event.

The most frequent renal event was microalbuminuria, followed by macroalbuminuria, doubling of creatinine to at least 200 µmol/L, renal-related death, and the need for renal replacement.

The most common retinal event was the need for laser therapy, followed by macular edema, proliferative retinopathy, and diabetes-related blindness.

As reported in Diabetes Care, patients in the highest tertile for HDL cholesterol (>1.34 mmol/L) at baseline had a 17% higher risk for a microvascular event than those in the lowest tertile (<1.1 mmol/L).

This finding was driven by a 19% higher risk for a renal event, a 14% higher risk for developing microalbuminuria, and a 42% increased risk for macroalbuminuria.

In contrast, there was no association found between baseline tertiles of HDL cholesterol and the development of retinopathy or any specific type of retinal event, suggesting that differences exist in the pathophysiology between the two types of microvascular disease, say Zoungas et al.

"Our findings provide the strongest evidence to date for a role of HDL-C [cholesterol] in the development and progression of diabetic nephropathy in patients with Type 2 diabetes," they remark.

"Additional research is needed to explore the possible benefit of therapies that increase HDL-C [cholesterol] in patients with Type 2 diabetes," concludes the team.

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