HDL Cholesterol and Triglycerides Drive CAD Risk in Diabetics

The combination of low HDL cholesterol and high triglycerides is associated with coronary artery disease (CAD) in patients with type 2 diabetes.

No previous study has directly compared LDL-lowering to HDL-raising in treating atherosclerosis, the authors explain, leaving it unclear which lipoprotein abnormalities are central for atherogenesis.

Dr. Heinz Drexel from Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria and colleagues examined serum lipid values, the presence of CAD, and the incidence of vascular events in 164 patients with type 2 diabetes, 314 patients with impaired fasting glucose, and 272 controls. The subjects were all Caucasians referred for coronary angiography for established or suspected CAD between September 1999 and October 2000.

Taking all subjects into consideration, the authors report, low HDL cholesterol levels were associated with the presence of significant CAD stenosis, but high total cholesterol and LDL cholesterol levels were not.

Similarly, in the subset of patients with type 2 diabetes, the results indicate, HDL cholesterol factors were significantly associated with coronary stenoses, whereas LDL cholesterol factors were not.

During a mean 2.3 years of follow-up, HDL cholesterol factors significantly predicted vascular events in patients with type 2 diabetes, the researchers note, but LDL cholesterol factors showed no association with the incidence of vascular events.
Elevated triglyceride levels also predicted an increased incidence of vascular events, the report indicates.

"The major driving force for coronary atherosclerosis in patients with type 2 diabetes appears to reside in the lipid triad of low HDL, high triglycerides, and small dense LDL," the authors write.

This triad was significantly associated with glycemia, angiographically defined coronary atherosclerosis, and was significantly predictive of clinical atherosclerosis events, they note.

"Clinical end point trials are now warranted to investigate the efficacy and safety of [HDL raising] drugs in addition to statin treatment to reduce cardiovascular events in patients with diabetes," the investigators write.
Diabetes Care 2005;28:108-114.

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FACT:
Final version of 2005 U.S.Dietary Guidelines to be released this week: it will have few changes, except for eating a balanced diet that is neither heavy in carbohydrates or fats but contains at least three servings of whole grains a day. Increase servings of vegetables and fruits; they should make up about half your plate at every meal and meat, fish or poultry less than 10 percent. The draft document also further reduces salt intake and specifically recommends low-fat milk and fish heavy in omega-3 fatty acids. It limits alcoholic drinks to one (women) or two (men) a day. The proposed guidelines also for the first time emphasize exercise, suggesting 30 to 90 minutes a day. In other words, eat better and exercise more.