Abstract
BackgroundPatients with type 1 diabetes (T1D) are at increased risk of cardiovascular disease (CVD). Measures of high-density lipoprotein (HDL) function provide a better risk estimate for future CVD events than serum levels of HDL cholesterol. The objective of this study was to evaluate HDL function in T1D patients shortly after disease onset compared with healthy control subjects.MethodsParticipants in the atherosclerosis and childhood diabetes study were examined at baseline and after 5 years. At baseline, the cohort included 293 T1D patients with a mean age of 13.7 years and mean HbA1c of 8.4%, along with 111 healthy control subjects. Their HDL function, quantified by HDL-apoA-I exchange (HAE), was assessed at both time points. HAE is a measure of HDL’s dynamic property, specifically its ability to release lipid-poor apolipoprotein A-I (apoA-I), an essential step in reverse cholesterol transport.ResultsThe HAE-apoA-I ratio, reflecting the HDL function per concentration unit apoA-I, was significantly lower in the diabetes group both at baseline, 0.33 (SD = 0.06) versus 0.36 (SD = 0.06) %HAE/mg/dL, p < 0.001 and at follow-up, 0.34 (SD = 0.06) versus 0.36 (SD = 0.06) %HAE/mg/dL, p = 0.003. HAE-apoA-I ratio was significantly and inversely correlated with HbA1c in the diabetes group. Over the 5 years of the study, the mean HAE-apoA-I ratio remained consistent in both groups. Individual changes were less than 15% for half of the study participants.ConclusionsThis study shows reduced HDL function, quantified as HAE-apoA-I ratio, in children and young adults with T1D compared with healthy control subjects. The differences in HDL function appeared shortly after disease onset and persisted over time.
Highlights
Patients with type 1 diabetes (T1D) are at increased risk of cardiovascular disease (CVD)
The focus has shifted to measures of high-density lipoprotein (HDL) function, which have yielded a better assessment of CVD risk than high-density lipoprotein cholesterol (HDL-C) quantification [8, 9]
The diabetes patients had higher diastolic blood pressure, HbA1c, total cholesterol, LDL cholesterol, apoB, apolipo‐ protein A-I (apoA-I), body weight, body mass index (BMI) and waist circumference compared with controls both at baseline and at the 5-year follow-up
Summary
Patients with type 1 diabetes (T1D) are at increased risk of cardiovascular disease (CVD). Measures of high-density lipoprotein (HDL) function provide a better risk estimate for future CVD events than serum levels of HDL cholesterol. Patients with type 1 diabetes (T1D) are at an increased risk of morbidity and mortality from cardiovascular disease (CVD) [1, 2]. In clinical studies high-density lipoprotein cholesterol (HDL-C) levels are consistently inversely associated with coronary heart disease events and mortality [4, 5]. CVD risk, nearly 40% of men with coronary heart disease have normal HDL-C levels [6], and very high HDL-C levels are associated with increased risk for major coronary events [7]. The focus has shifted to measures of HDL function, which have yielded a better assessment of CVD risk than HDL-C quantification [8, 9]
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