Abstract 12916: Association Between High Density Lipoprotein Cholesterol, Apolipoprotein-A1 and Long Term Glycemia: The FIELD Study
Background: Low levels of HDL-C, a cardiovascular risk factor, are common in pre-diabetes and Type 2 Diabetes Mellitus (T2DM). Pre-clinical evidence suggests that HDL can lower blood glucose by increasing insulin secretion and lowering peripheral insulin resistance. We hypothesized that low levels of HDL-C and its major apolipoprotein, Apo-A1, would be associated with lower concurrent insulin secretion and more glycemia and insulin resistance, and that lower levels may predict future deterioration in glycemia.
Methods: Analyses were of subjects enrolled in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial. HbA1c and fasting serum HDL-C and Apo-A1 were measured in central laboratories. Baseline correlations between variables were assessed in all 9795 FIELD subjects. In those subject not taking insulin (n=8272), fasting plasma glucose and serum insulin were used to calculate Homeostasis Model Assessment estimates of pancreatic β-cell secretion (HOMA-B) and insulin resistance (HOMA-IR). Among all 1317 subjects in the placebo arm treated with dietary and lifestyle therapy only at baseline, regression analyses tested whether higher HDL-C or Apo-A1 levels predicted lower uptake of Oral Hypoglycemic Agents (OHAs) and insulin at the end of 5 years median follow-up.
Results: At baseline, HDL-C and Apo-A1 were both inversely correlated with HOMA-IR (r=-0.179, p≤0.001 and r=-0.085, p≤0.001), but not related to HbA1c (age and sex adjusted, p>0.05) or HOMA-B (age, sex and HOMA-IR adjusted, p>0.05). At the end of follow up, higher baseline HDL-C, (OR = 1.85 per mmol/L, p=0.007) but not Apo-A1 (OR = 1.73 per g/L, p=0.060) was associated with lower use of OHAs and insulin therapy (age and sex adjusted).
Conclusions: In the large FIELD study in T2DM, baseline HDL-C and Apo-A1 levels related to concurrent measures of insulin resistance, but not HbA1c levels. Higher HDL-C levels were associated with less deterioration in glycemic control over 5 years as reflected by a lower uptake of OHAs and insulin therapy.
- © 2013 by American Heart Association, Inc.