HealthDay News – For patients with type 2 diabetes with low-density lipoprotein cholesterol (LDL-C) levels <2.0 mmol/L, higher high-density lipoprotein cholesterol (HDL-C) is associated with increased risk for cardiovascular events and all-cause mortality, according to a study published online May 23 in Diabetes Care.

Shahnam Sharif, MD, from the University Medical Center Utrecht in the Netherlands, and colleagues performed a prospective cohort study of 1829 patients with type 2 diabetes in the Second Manifestations of ARTerial disease (SMART) cohort. The authors examined the risk of HDL-C on cardiovascular events and all-cause mortality. Analyses were performed in strata of LDL-C levels and lipid-lowering therapy intensity.

Researchers found that during a median follow-up of 7.0 years there were 335 new cardiovascular events and 385 deaths. Plasma HDL-C was not related to cardiovascular events (hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.93-1.01) or all-cause mortality (HR: 0.99; 95% CI: 0.96-1.03). 

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The effect was modified by plasma LDL-C levels. For patients with LDL-C levels <2.0 mmol/L, higher HDL-C was associated with higher risk of all-cause mortality (HR: 1.14; 95% CI: 1.07-1.21) and higher risk for cardiovascular events (HR: 1.10; 95% CI: 1.07-1.21), compared with patients with LDL-C levels between 2.0 and 2.5 mmol/L or >2.5 mmol/L.

“Future studies are needed to confirm this finding and investigate the causality,” the authors wrote.


Sharif S, van der Graaf Y, Nathoe HM, et al; on behalf of the SMART Study Group. HDL cholesterol as a residual risk factor for vascular events and all-cause mortality in patients with type 2 diabetes. Diabetes Care. 2016. doi: 10.2337/dc16-0155.