Discordant risk assessment using non-HDL cholesterol and LDL cholesterol levels in patients with type-2 diabetes

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 776-795-Cardiometabolic Risk & Vascular Biology
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-779
Mario Skugor1 and Kanjanee Thanapase*2
1Cleveland Clinic, Cleveland, OH, 2Cleveland Clinic, Cleveland
Background and objective

Type 2 diabetes is associated with an increased risk for cardiovascular disease. This risk is largery due to diabetic dyslipidemia, which is characterized by high triglyceride, reduced high-density lipoprotein cholesterol (HDL-C), and low or relatively normal low-density lipoprotein cholesterol (LDL-C). Despite achieving desirable LDL cholesterol levels, the residual cardiovascular risk remains high among patients with diabetes. This is partly of the increased number of non-LDL atherogenic particles. Assessment of non-high-density lipoprotein cholesterol (non-HDL-C) provides a measure of all atherogenic particles. Current guideline from the National Cholesterol Education Program (NCEP) rely on non-HDL-C as a secondary target of therapy in patients with diabetes.

This study aimed to determine the concordance between non-HDL and LDL cholesterol in diabetic patients with different triglyceride and HbA1c levels.

Methods and results

Data from 650 diabetes patients and 4515 fasting lipid profile tests from a Cleveland clinic EPIC database, were analyzed. Of the patients with LDL cholesterol <100 mg/dL, 55.6% had correspondingly low levels of non-HDL cholesterol (<130 mg/dL). Of the patients with LDL cholesterol >100 mg/dL, 32% had correspondingly low levels of non-HDL cholesterol (>130 mg/dL). However, 5.3% had LDL level <100 mg / dL, but non-HDL level >130 mg/dL were significant high triglyceride level (mean TG level 380 mg/dL) and slightly high HbA1C (mean HbA1C 8.2%). 7% had LDL level >100 mg / dL, but non-HDL level <130 mg/dL were low triglyceride level (mean TG level 83 mg/dL) and HbA1C (mean HbA1C 7.7%).

Conclusion

About 13% of the patients with type-2 diabetes have discordant risk assessment using the LDL or Non-HDL cholesterol as a risk assessor. Non-HDL cholesterol tends to indicate more risk in individuals with higher triglyceride level (more than 165 mg/dL). LDL cholesterol tends to indicate more risk in individuals with low triglyceride levels (less than 165 mg/dL). We would recommend determination of both and using the one that indicates more risk as guide for therapeutic intervention. Advantage of Non-HDL cholesterol is that it can be calculated in non-fasting state. Further, prospective studies are necessary to determine which measure performs better in different populations as a true risk predictor.

Nothing to Disclose: MS, KT

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm