Author:
Jin Qiao,Lau Eric S. H.,Luk Andrea O.,Tam Claudia H. T.,Ozaki Risa,Lim Cadmon K. P.,Wu Hongjiang,Chow Elaine Y. K.,Kong Alice P. S.,Lee Heung Man,Fan Baoqi,Ng Alex C. W.,Jiang Guozhi,Lee Ka Fai,Siu Shing Chung,Hui Grace,Tsang Chiu Chi,Lau Kam Piu,Leung Jenny Y.,Tsang Man-wo,Cheung Elaine Y. N.,Kam Grace,Lau Ip Tim,Li June K.,Yeung Vincent T.,Lau Emmy,Lo Stanley,Fung Samuel,Cheng Yuk Lun,Chow Chun Chung,Yu Weichuan,Tsui Stephen K. W.,Huang Yu,Lan Hui-yao,Szeto Cheuk Chun,So Wing Yee,Jenkins Alicia J.,Chan Juliana C. N.,Ma Ronald C. W.,
Abstract
Abstract
Objective
High-density lipoproteins (HDL) comprise particles of different size, density and composition and their vasoprotective functions may differ. Diabetes modifies the composition and function of HDL. We assessed associations of HDL size-based subclasses with incident cardiovascular disease (CVD) and mortality and their prognostic utility.
Research design and methods
HDL subclasses by nuclear magnetic resonance spectroscopy were determined in sera from 1991 fasted adults with type 2 diabetes (T2D) consecutively recruited from March 2014 to February 2015 in Hong Kong. HDL was divided into small, medium, large and very large subclasses. Associations (per SD increment) with outcomes were evaluated using multivariate Cox proportional hazards models. C-statistic, integrated discrimination index (IDI), and categorial and continuous net reclassification improvement (NRI) were used to assess predictive value.
Results
Over median (IQR) 5.2 (5.0–5.4) years, 125 participants developed incident CVD and 90 participants died. Small HDL particles (HDL-P) were inversely associated with incident CVD [hazard ratio (HR) 0.65 (95% CI 0.52, 0.81)] and all-cause mortality [0.47 (0.38, 0.59)] (false discovery rate < 0.05). Very large HDL-P were positively associated with all-cause mortality [1.75 (1.19, 2.58)]. Small HDL-P improved prediction of mortality [C-statistic 0.034 (0.013, 0.055), IDI 0.052 (0.014, 0.103), categorical NRI 0.156 (0.006, 0.252), and continuous NRI 0.571 (0.246, 0.851)] and CVD [IDI 0.017 (0.003, 0.038) and continuous NRI 0.282 (0.088, 0.486)] over the RECODe model.
Conclusion
Small HDL-P were inversely associated with incident CVD and all-cause mortality and improved risk stratification for adverse outcomes in people with T2D. HDL-P may be used as markers for residual risk in people with T2D.
Funder
the Research Grants Council of the Hong Kong Special Administrative Region
the NSFC-NHMRC Joint Research Scheme
Research Grants Council Theme-based Research Scheme
a Croucher Foundation Senior Medical Research Fellowship, and Research Grants Council Senior Research Fellow
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Endocrinology, Diabetes and Metabolism