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Cholesterol ratio may predict type 2 diabetes risk

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February 21, 2018

In adults aged at least 40 years, the non-HDL cholesterol/HDL cholesterol ratio is an independent risk factor for developing type 2 diabetes independent of age, sex and BMI, according to findings from researchers in China.

Lu Lu Chen, MD, PhD , of the department of endocrinology at Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, and colleagues analyzed data from 4,882 adults aged at least 40 years participating in REACTOIN, a prospective study collecting data from 25 centers in China between October 2011 and February 2012 (mean age, 55 years; 36.6% men; mean BMI, 23.3 kg/m²). Participants completed a standardized questionnaire, attended clinic visits and underwent an oral glucose tolerance test. Researchers measured LDL cholesterol, HDL cholesterol, total cholesterol and fasting insulin and calculated insulin resistance. Non-HDL cholesterol/HDL cholesterol ratio was log 10-transformed to reach normal distribution. Researchers used logistic regression analysis to assess the association between log transformed non-HDL cholesterol/HDL cholesterol ratio with diabetes.

Over a mean 3 years of follow-up, 704 participants developed diabetes.

Researchers observed that participants in the top quartile for non-HDL cholesterol/HDL cholesterol ratio had a mean of 0.2 mmol/L FPG (beta = 0.2; 95% CI, 0.2-0.3), a mean of 0.5 mmol/L higher 2-hour glucose level (beta = 0.5; 95% CI, 0.3-0.7), a mean of 0.1% higher HbA1c (beta = 0.1; 95% CI, 0.1-0.2) and a 40% increased risk for diabetes (OR = 1.4; 95% CI, 1.1-1.8) vs. participants in the lowest quartile for non-HDL cholesterol/HDL cholesterol ratio. Results persisted after adjustment for age, sex, smoking status, alcohol consumption, physical activity, BMI, systolic blood pressure and family history of diabetes.

In analysis using log transformed non-HDL cholesterol/HDL cholesterol ratio as a quantitative variable, researchers found that each SD increase in log transformed non-HDL cholesterol/HDL cholesterol ratio was associated with a 0.1 mmol/L higher FPG (beta = 0.1; 95% CI, 0.1-0.1), a 0.2 mmol/L higher 2-hour glucose level (beta = 0.2; 95% CI, 0.1-0.2) and a 10% increased risk for diabetes (OR = 1.1; 95% CI, 1-1.2).

“Our study extends previous findings that higher non-HDL [cholesterol]/HDL [cholesterol] levels are not only associated with higher insulin resistance and higher FPG levels, but higher post-load glucose levels, higher HbA1c levels and higher diabetes risk as well,” the researchers wrote, adding that non-HDL cholesterol/HDL cholesterol levels were associated with a larger increase in post-load glucose vs. the increase in FPG levels.

“Since post-load glucose levels depend more on the early- and late-phase insulin secretion vs. FPG, our results suggested that non-HDL [cholesterol]/HDL [cholesterol] levels might be more related to beta-cell function,” the researchers wrote. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.