02107nas a2200229   4500000000100000008004100001100001300042700001400055700001300069700001000082700001800092700001900110700001500129700001600144700001800160700001600178700001800194245010700212250001500319520149700334020004601831       2012                            d1 aLi Qiang1 aMorton J.1 aStolk R.1 aNg M.1 aWoodward Mark1 aZoungas Sophia1 aBeulens J.1 aGlasziou P.1 aCelermajer D.1 aChalmers J.1 aPatel Anushka00aLow HDL Cholesterol and the Risk of Diabetic Nephropathy and Retinopathy: Results of the ADVANCE study  a2012/08/153 a<p>
OBJECTIVEAlthough low HDL cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and the risk of microvascular disease are limited. We tested the association between HDL-C and microvascular disease in a cohort of patients with type 2 diabetes.RESEARCH DESIGN AND METHODSA total of 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazards models were used to assess the association between baseline HDL-C and the development of new or worsening microvascular disease, defined prospectively as a composite of renal and retinal events.RESULTSThe mean baseline HDL-C level was 1.3 mmol/L (SD 0.45 mmol/L [range 0.1-4.0]). During follow-up, 32% of patients developed new or worsening microvascular disease, with 28% experiencing a renal event and 6% a retinal event. Compared with patients in the highest third, those in the lowest third had a 17% higher risk of microvascular disease (adjusted hazard ratio 1.17 [95% CI 1.06-1.28], P = 0.001) after adjustment for potential confounders and regression dilution. This was driven by a 19% higher risk of renal events (1.19 [1.08-1.32], P = 0.0005). There was no association between thirds of HDL-C and retinal events (1.01 [0.82-1.25], P = 0.9).CONCLUSIONSIn patients with type 2 diabetes, HDL-C level is an independent risk factor for the development of microvascular disease affecting the kidney but not the retina.
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