Cardiovascular Diabetology (Dec 2022)

High-density lipoprotein subclasses and cardiovascular disease and mortality in type 2 diabetes: analysis from the Hong Kong Diabetes Biobank

  • Qiao Jin,
  • Eric S. H. Lau,
  • Andrea O. Luk,
  • Claudia H. T. Tam,
  • Risa Ozaki,
  • Cadmon K. P. Lim,
  • Hongjiang Wu,
  • Elaine Y. K. Chow,
  • Alice P. S. Kong,
  • Heung Man Lee,
  • Baoqi Fan,
  • Alex C. W. Ng,
  • Guozhi Jiang,
  • Ka Fai Lee,
  • Shing Chung Siu,
  • Grace Hui,
  • Chiu Chi Tsang,
  • Kam Piu Lau,
  • Jenny Y. Leung,
  • Man-wo Tsang,
  • Elaine Y. N. Cheung,
  • Grace Kam,
  • Ip Tim Lau,
  • June K. Li,
  • Vincent T. Yeung,
  • Emmy Lau,
  • Stanley Lo,
  • Samuel Fung,
  • Yuk Lun Cheng,
  • Chun Chung Chow,
  • Weichuan Yu,
  • Stephen K. W. Tsui,
  • Yu Huang,
  • Hui-yao Lan,
  • Cheuk Chun Szeto,
  • Wing Yee So,
  • Alicia J. Jenkins,
  • Juliana C. N. Chan,
  • Ronald C. W. Ma,
  • the Hong Kong Diabetes Biobank Study Group

DOI
https://doi.org/10.1186/s12933-022-01726-y
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 13

Abstract

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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.

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