Abstract 9424: Low In-Treatment HDL Cholesterol Levels Strongly Predict the Development of New Diabetes Mellitus: The LIFE Study
Background: Hypertensive patients are at increased risk of developing diabetes mellitus (DM). Although low baseline HDL levels predict a higher incidence of DM, whether changing levels of HDL over time are more strongly related to the risk of new DM has not been examined..
Methods: Incident DM was examined in relation to baseline and in-treatment HDL levels prior to development of DM in 7445 hypertensive patients with no history of DM who were randomly assigned to losartan- or atenolol-based treatment. HDL levels at baseline and each year of testing were categorized into quartiles according to baseline HDL levels.
Results: During 4.6±1.2 years follow-up, new DM developed in 520 patients (6.9%). In univariate analyses, compared with HDL >1.78 mMol/L, baseline and in-treatment HDL <1.21 entered as a time-varying covariate identified patients with >5 and >9-fold higher risk of new DM respectively; patients with baseline or in-treatment HDL in the 2nd or 3rd quartiles had intermediate increased risk of DM. In multivariate Cox analyses adjusting for randomized treatment, baseline age, sex, race, prior antihypertensive therapy, body mass index (BMI), serum glucose (and baseline HDL for in-treatment HDL) treated as standard covariates, and in-treatment Cornell product LVH, diastolic and systolic pressure, BMI, hydrochlorothiazide and statin use treated as time-varying covariates, the lowest quartile of in-treatment HDL remained associated with a >9-fold increased risk of new DM whereas the risk of new DM was significantly attenuated for baseline HDL <1.21.
Conclusions: Lower in-treatment HDL is more strongly associated with increased risk of new DM than baseline HDL, even after adjusting for other potential DM risk factors and treatment effects. These findings suggest the use of serial assessment of serum HDL to better estimate risk of new DM in hypertensive patients. Further study is indicated to determine whether therapies that increase HDL can lower risk of developing DM.
- © 2010 by American Heart Association, Inc.