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

Citation
Lee, J. S., et al. “Triglyceride And Hdl-C Dyslipidemia And Risks Of Coronary Heart Disease And Ischemic Stroke By Glycemic Dysregulation Status: The Strong Heart Study.”. Diabetes Care, pp. 529-537.
Center Albert Einstein College of Medicine
Author Jennifer S Lee, Po-Yin Chang, Ying Zhang, Jorge R Kizer, Lyle G Best, Barbara Howard V
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 1.06-1.64) 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 1.15-2.06) for CHD ( value for interaction = 0.003) and a 2.13-fold greater HR (95% CI 1.06-4.29) for stroke ( value for interaction = 0.060). High TG and low HDL level was associated with CHD risk in participants with an 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.

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.

Year of Publication
2017
Journal
Diabetes care
Volume
40
Issue
4
Number of Pages
529-537
Date Published
04/2017
ISSN Number
1935-5548
DOI
10.2337/dc16-1958
Alternate Journal
Diabetes Care
PMID
28122840
PMCID
PMC5360283
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