HDL cholesterol, stroke and diabetes

Low levels of high-density lipoprotein (HDL) cholesterol increase the risk for stroke in elderly type 2 diabetic patients, according to recent results of the Japan Cholesterol and Diabetes Mellitus study. The study was reviewed by HDL Forum Editor Professor Philip Barter.

Hayashi T, Kawashima S, Itoh H et al. Low HDL cholesterol is associated with the risk of stroke in elderly diabetic individuals. Diabetes Care 2009;32:1221-3.

 Stroke is a leading cause of death and disability in Japan (1). Epidemiological data support a significant, independent inverse association between HDL cholesterol and stroke in Japanese subjects (2). However, there is sparse information in those with diabetes, especially older subjects. This has been the focus of the Japan Cholesterol and Diabetes Mellitus study.

 The Japan Cholesterol and Diabetes Mellitus study was a prospective, single-centre cohort study in 4,014 type 2 diabetic patients (1,936 women) aged between 35-83 years (mean 67.4 years). None of the patients had pre-existing ischemic heart disease (IHD) or stroke. Over a 2-year follow-up period, 1.59% of subjects had experienced an IHD event (myocardial infarction, unstable angina, angioplasty or coronary artery bypass graft) and 1.43% experienced stroke.

 Multivariate analysis of factors associated with stroke confirmed a significant relationship between stroke and HDL cholesterol in older subjects (aged 65-74 and 75 years or more, odds ratio 0.511, 95% CI 0.239-0.918, p<0.05).  

An HDL cholesterol value of <44 mg/dL increased the risk of stroke by nearly-2-fold in the 65-74 year age group, and even more in those aged ³75 years (adjusted odds ratio 1.99 vs. 2.62 vs. 1.13 in those aged <65 years) (Table 1).

 

Statin treatment did not appear to influence this risk. Subjects who were prescribed statins but had HDL cholesterol values <40 mg/dL had the same elevated risk of stroke (data not shown). There was no significant relationship between LDL cholesterol, triglycerides, fasting blood glucose and HbA1c and risk of stroke.

 The authors concluded that the study had shown the importance of HDL cholesterol as a risk factor for stroke in elderly Japanese subjects with diabetes. In addition, the authors highlighted the importance of therapeutic intervention aimed at raising HDL cholesterol, especially in those aged 75 years or more.

 References

1. Kubo M, Kiyohara Y, Kato I et al. Trend in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese community. The Hisayama study. Stroke 2003; 34: 2349–54.

2. Soyama Y, Miura K, Morikawa Y et al. High-density lipoprotein cholesterol and risk of stroke in Japanese men and women: the Oyabe Study. Stroke 2003;34:863-8.

 

 


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