Total/high density lipoprotein cholesterol and cardiovascular disease (re)hospitalization nadir in type 2 diabetes

Dahai Yu,Yamei Cai,Rui Qin,Jonathan Graffy,Daniel Holman,Zhanzheng Zhao,David Simmons

doi:10.1194/jlr.p084269

Abstract

Total cholesterol to HDL cholesterol ratio (TC/HDL) is an important prognostic factor for CVD. This study used restricted cubic spline modeling to investigate the dose-response associations between TC/HDL and both CVD hospitalization and CVD rehospitalization in two independent prospective cohorts. The East Cambridgeshire and Fenland cohort includes 4,704 patients with T2D from 18 general practices in Cambridgeshire. The Randomized controlled trial of Peer Support In type 2 Diabetes cohort comprises 1,121 patients with T2D with posttrial follow-up data. TC/HDL and other demographic and clinical measurements were measured at baseline. Outcomes were CVD hospitalization over 2 years and CVD rehospitalization after 90 days of the prior CVD hospitalization. Modeling showed nonlinear relationships between TC/HDL and risks of CVD hospitalization and rehospitalization consistently in both cohorts (all P < 0.001 for linear tests). The lowest risks of CVD hospitalization and rehospitalization were consistently found for TC/HDL at 2.8 (95% CI: 2.6-3.0) in both cohorts and both overall and by gender. This is lower than the current lipid control target, 4.0 of TC/HDL. Reducing the TC/HDL target to 2.8 would include a further 33-44% patients with TC/HDL in the 2.8-4.0 range. Studies are required to assess the effectiveness and cost-effectiveness of the earlier introduction of, and more intensive, lipid-lowering treatment needed to achieve this new lower TC/HDL target.

Highlights

Total cholesterol to HDL cholesterol ratio (TC/ HDL) is an important prognostic factor for CVD
As one of the most dominant risk factors, dyslipidemia has been found to be associated with coronary heart disease (CHD) among people with T2D in large prospective studies such as the UK Prospective Diabetes Study (UKPDS) [1, 2]
Among various lipid profile measurements, the total cholesterol to HDL cholesterol ratio (TC/HDL) has been widely used as a prognostic factor to predict the risk of CVD both in general [3] and diabetes populations, as applied in the UKPDS score, reflecting its association both with CHD [4] and stroke in people with T2D

Summary

Introduction

Total cholesterol to HDL cholesterol ratio (TC/ HDL) is an important prognostic factor for CVD. The lowest risks of CVD hospitalization and rehospitalization were consistently found for TC/HDL at 2.8 (95% CI: 2.6–3.0) in both cohorts and both overall and by gender This is lower than the current lipid control target, 4.0 of TC/HDL. As one of the most dominant risk factors, dyslipidemia has been found to be associated with coronary heart disease (CHD) among people with T2D in large prospective studies such as the UK Prospective Diabetes Study (UKPDS) [1, 2] Both total and LDL cholesterol have been found to correlate with risk of CHD consistently over different studies [5]. Among various lipid profile measurements, the total cholesterol to HDL cholesterol ratio (TC/HDL) has been widely used as a prognostic factor to predict the risk of CVD both in general [3] and diabetes populations, as applied in the UKPDS score, reflecting its association both with CHD [4] and stroke in people with T2D

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