Associations of non-high-density lipoprotein cholesterol with the prevalence and risk of type 2 diabetes mellitus in an urban siberian population

The aim – to investigate the associations of non-high-density lipoprotein cholesterol (non-HDL-C) levels and atherogenic coefficient (AC) – defined as the ratio of non-HDL-C to HDL-C–with the prevalence and risk of developing type 2 diabetes (T2D) in a population aged 45–69 years in Novosibirsk.

Material and methods. Using data from the HAPIEE project (2003–2005), we assessed the odds ratio (OR) for prevalent T2DM in a cross-sectional analysis (n = 9.360) and the risk (OR) of incident T2DM in a prospective cohort (n = 3.048) across different non-HDL-C levels. Mean follow-up duration was 14.6 ± 0.7 years. T2DM risk was evaluated using multivariate logistic regression analysis with sequential adjustment for confounders and quartile (Q)-based standardization of lipid parameters.

Results. In the cross-sectional analysis, non-HDL-C ≥ 4.5 mmol/L was associated with an increased odds of prevalent T2DM in the presence of concomitant hypertriglyceridemia (OR = 1.31; p = 0.001), independently of sex, age, and BMI. In the prospective cohort analysis, each 1 mmol/L increase in non-HDL-C elevated T2DM risk by 25 % in men and 14 % in women; each 1-unit increase in AC raised the risk by 41 % and 28 %, respectively. In quartile comparisons, men with non-HDL-C ≥ 4.5 versus < 3.6 mmol/L had a 1.7-fold higher risk of incident T2DM after adjustment for age, smoking, alcohol consumption, family history of diabetes, and arterial hypertension, except for waist circumference (WC). Women with nonHDL-C ≥ 5.6 versus < 3.9 mmol/L had a 1.4-fold increased risk after similar adjustments, except for hypertension and WC. For AC, values ≥ 3.2 versus < 2.4 doubled T2DM risk in men, while values ≥ 3.1 versus < 2.4 increased risk 1.6-fold in women. These associations persisted after adjustment for age and conventional risk factors, except for WC.

Conclusions. In the cross-sectional analysis, non-HDL-C levels ≥ 4.5 mmol/L were associated with increased odds of prevalent T2DM in the presence of hypertriglyceridemia ≥ 1.7 mmol/L, independently of sex, age, and BMI. In the prospective analysis, elevated non-HDL-C was associated with higher risk of incident T2DM after multivariable adjustment, with the exception of WC in men and hypertension and WC in women. Similar patterns were observed for the association between AC and T2DM risk after adjustment for the same covariates, except for WC in both sexes.

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