OP33 LOWER HDL CHOLESTEROL IS ASSOCIATED WITH THE RISK OF STROKE IN DIABETIC INDIVIDUALS WITH POOR GLYCEMIC CONTROL: 5.5-YEAR SURVEY OF CARDIOVASCULAR EVENTS

Abstract

Background: The aim of this study was to identify factors that predict ischemic heart disease (IHD) or cerebrovascular accident (CVA) in diabetic individuals and to investigate their differences by age. We investigated the relationship between lipid levels and IHD and CVA in diabetic individuals according to glycated hemoglobin (HbA1c, 7.9% or <7.9%). Method: We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) with 5.5 years of follow-up. A total of 4,014 patients with type 2 diabetes (1,936 women; age 67.4±9.5 years, median 70 years; <65 years old, n=1,261; 65 to 74 years old, n=1,731; and 75 years old, n=1,016) were recruited on a consecutive outpatient basis from 40 hospitals throughout Japan. Patients with coronary artery disease, which was defined as previous myocardial infarction, coronary intervention, or confirmed angina pectoris and recent stroke, who had been admitted within the past 24 months were excluded. The primary end points were onset of IHD or CVA. Lipids, glucose and other factors related to IHD or CVA risk were investigated. Result: The diabetic participants were divided into those who were aged <65 years, 65–74 years and 75 years. 153 cases of IHD and 104 cases of CVA (7.8 and 5.7/1,000 people per year, respectively) occurred over 5.5 years. Lipid and glucose levels and other factors were investigated in relation to the occurrence of IHD or CVA. In this study, we focused on HbA1c levels. HDL-cholesterol (HDL-C) was significantly associated with risk of CVA in diabetic individuals with poor glycemic control (HbA1c 7.9%) who were aged <65 years. Triglyceride (TG) was significantly associated with risk of CVA in diabetic individuals with poor glycemic control (HbA1c 7.9%) who were aged 75 years. HDL-C, LDL-cholesterol (LDL-C) and TG were not significantly associated with risk of CVA in diabetic individuals (HbA1c <7.9%). HDL-C, LDL-C and TG were not significantly associatedwith risk of IHD in diabetic individuals (HbA1c, 7.9% and <7.9%). Risk factors for cardiovascular events appear to change with advancing age. The importance of HDL-C is different for each age-group. Conclusion: Lower HDL-C was an important risk factor for CVA in diabetic individuals with poor glycemic control who were aged <65 years. This result is important for developing individualized strategies to prevent atherosclerotic disease.