Triglyceride and HDL-C Dyslipidemia and Risks of Coronary Heart Disease and Ischemic Stroke by Glycemic Dysregulation Status: The Strong Heart Study

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1 1/5 Triglyceride and HDL-C Dyslipidemia and Risks of Coronary Heart Disease and Ischemic Stroke by Glycemic Dysregulation Status: The Strong Heart Study Jennifer S. Lee, Po-Yin Chang, Ying Zhang, Jorge R. Kizer, Lyle G. Best, Barbara V. Howard Diabetes Care 2017 Jan; dc Previous Next Article Info & Metrics PDF Abstract OBJECTIVE High triglyceride (TG) levels and low HDL cholesterol (HDL-C) levels are risk factors for cardiovascular disease. It is unclear whether this relationship depends on glycemic dysregulation, sex, or LDL cholesterol (LDL-C) level. RESEARCH DESIGN AND METHODS We studied 3,216 participants (40% men, 41% with diabetes) who were free of cardiovascular disease at baseline in a community-based, prospective cohort of American Indians (median follow-up 17.7 years). Cox models estimated hazard ratios (HRs) and 95% CIs for incident ischemic stroke and coronary heart disease (CHD) in relation to combined TG and HDL-C status, where a fasting TG level 150 mg/dl was high and a fasting HDL-C level <40 mg/dl for men (<50 mg/dl for women) was low. Models included age, sex, BMI, smoking, diabetes, fasting LDL-C level, antihypertensive medications, physical activity, estimated glomerular filtration rate, and urinary albumin-to-creatinine ratio. RESULTS Participants with high TG and low HDL levels had a 1.32-fold greater HR (95% CI ) for CHD than those with normal TG and normal HDL levels. It was observed in participants with diabetes, but not in those without diabetes, that high TG plus low HDL levels were associated with a 1.54-fold greater HR (95% CI ) for CHD (P value for interaction = 0.003) and a 2.13-fold greater HR (95% CI ) for stroke (P value for interaction = 0.060). High TG and low HDL level was associated with CHD risk in participants with a LDL-C level of 130 mg/dl, but this was not observed in those participants with lower LDL-C levels. Sex did not appear to modify these associations.

2 2/5 CONCLUSIONS Adults with both high TG and low HDL-C, particularly those with diabetes, have increased risks of incident CHD and stroke. In particular, those with an LDL-C level 130 mg/dl may have an increased risk of incident stroke. Received September 10, Accepted January 2, by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at Log in using your username and password Username Password Log in Forgot your user name or password? Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$35.00 Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired. We recommend Triglycerides and amputation risk in patients with diabetes: ten-year follow-up in the DISTANCE study. Brian C Callaghan et al., Diabetes Care, 2011 Does elevated plasma triglyceride level independently predict impaired fasting glucose?: the Multi-Ethnic Study of Atherosclerosis (MESA). Susan X Lin et al., Diabetes Care, 2012 The ACCORD (Action to Control Cardiovascular Risk in Diabetes) Lipid trial: what we learn from subgroup analyses. Henry N Ginsberg, Diabetes Care, 2011 Insulin resistance and cardiovascular events with low HDL cholesterol: the Veterans Affairs HDL Intervention Trial (VA-HIT). Sander J Robins et al., Diabetes Care, 2003 Awareness, treatment, and control of LDL cholesterol are lower among U.S. adults with undiagnosed diabetes versus diagnosed diabetes. Todd M Brown et al., Diabetes Care, 2013 Lipid Levels Have Contrasting Effects on Coronary Artery Disease and Diabetes Association of Lipids and Heart Disease in Contemporary Studies PracticeUpdate, 2015 Is Isolated Low HDL a Cardiovascular Risk Factor? Fenofibrate Therapy Reduces Long-Term Cardiovascular Risk in Statin-Treated Patients With Type 2 Diabetes PracticeUpdate, 2017 The Association of Type 2 Diabetes With Lipoproteins, Insulin Resistance, and Rosuvastatin

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