Both low-density lipoproteins (LDL) and high-density lipoproteins (HDL) particle concentrations associate positively with an increased risk of developing microvascular complications in patients with type 2 diabetes: lost protection by HDL (Zodiac-63)
Authors' conclusion
Total lipoprotein particle concentrations of both LDL and HDL associate positively with an increased risk of developing microvascular complications in T2D. We propose that the protective role of HDL on the development of microvascular complications may be lost in established T2D.
Study context
- Population
- Patients with T2D in the primary care-based ZODIAC cohort; lipoprotein particles measured by nuclear magnetic resonance (NMR) (Vantera, LP4 algorithm)142 without complications at baseline
- Participants
- 278 patients
- Exposure
- Per 1 SD increment in lipoprotein particle concentrations
- Outcome
- Incident microvascular complications (nephropathy, neuropathy, retinopathy)
- Follow-up
- Median 3.2 years
Methodological detailsprimary care-based, longitudinal, multivariable Cox proportional hazards regression
- Primary care-based
- Longitudinal
- Multivariable Cox proportional hazards regression
Main finding
As reported in the abstract
Any incident microvascular complication
Adjusted hazard ratio (95% CI)P value
Total LDLP (per 1 SD)
1.70(1.24–2.34)
P < 0.001Total HDLP (per 1 SD)
1.63(1.19–2.23)
P = 0.002Per 1 SD, as printed
- Patients without baseline complications developing new-onset microvascular complications
- 49 (34.5%) of 142
Observational data: associations, not effects.
Further findings
Retinopathy
| aHR (95% CI) | P value | ||
|---|---|---|---|
| Total LDLP | 3.35 (1.35–8.30) | P = 0.009 | |
| 0.10.31310Adjusted hazard ratio (log scale) |
Nephropathy
| aHR (95% CI) | P value | ||
|---|---|---|---|
| Total LDLP | 2.13 (1.27–3.35) | P = 0.004 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Neuropathy
| aHR (95% CI) | P value | ||
|---|---|---|---|
| Total HDLP | 1.77 (1.15–2.70) | P = 0.009 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Lipoprotein particle subfractions
- No significant associations for lipoprotein particle subfractions
Microvascular complications at baseline
- Patients with microvascular complications at baseline
- 136
Original publication
Both LDL and HDL particle concentrations associate positively with an increased risk of developing microvascular complications in patients with type 2 diabetes: lost protection by HDL (Zodiac-63). Cardiovasc Diabetol. Published 6 July 2023. doi:10.
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