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Diabetologia (2004) 47:21292136DOI 10.1007/s00125-004-1593-2Joint role of non-HDL cholesterol and glycated haemoglobin
in predicting future coronary heart disease events among women
with type 2 diabetesM. B. Schulze1, 7 I. Shai1, 2, 3 J. E. Manson2, 4, 5 T. Li1 N. Rifai6 R. Jiang1, 2 F. B. Hu1, 2, 51 Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA2 Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA3 S. Daniel Abraham International Center for Health and Nutrition, Department of Epidemiology, Ben-Gurion University,
Beer-Sheva, Israel4 Division of Preventive Medicine, Department of Medicine, Brigham and Womens Hospital and Harvard Medical School,
Boston, Massachusetts, USA5 Channing Laboratory, Department of Medicine, Brigham and Womens Hospital and Harvard Medical School, Boston,
Massachusetts, USA6 Department of Laboratory Medicine, Childrens Hospital and Harvard Medical School, Boston, Massachusetts, USA7 Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, GermanyAbstractAims/hypothesis. Non-HDL cholesterol (the sum of
LDL, VLDL and IDL cholesterol) is considered to be
particularly valuable in the management of dyslipidaemia in type 2 diabetes. However, it remains uncertain whether the association between non-HDL cholesterol and cardiovascular risk in type 2 diabetes depends on the status of hyperglycaemia. We aimed to
determine whether non-HDL cholesterol predicts
CHD events among diabetic women independently of
currently established risk factors and the status of glycaemic control.Methods. We prospectively followed 921 diabetic
women in the Nurses Health Study, who were free of
cardiovascular disease at the time that blood was
drawn in 1989/90. During 10 years of follow-up, we
identified 122 incident CHD cases.Results. After adjustment for age, BMI, smoking, alcohol consumption, and other lifestyle risk factors, the
multivariate relative risks (RRs) of CHD for extreme
quartiles were 1.97 (95% CI: 1.143.43) for non-HDL
cholesterol, 1.78 (1.023.11) for apolipoprotein B-
100, and 1.93 (1.153.22) for LDL cholesterol. However, the association between non-HDL cholesterol
and CHD risk was only apparent among women with
elevated fasting triglycerides (RR for extreme quartiles: 3.80; p=0.045). HbA1c was strongly associated
with increased CHD risk (RR for increase by 1 unit:1.24; 95% CI: 1.131.35), and both non-HDL cholesterol and HbA1c additively predicted CHD risk (RR
for the combination of high non-HDL cholesterol and
high HbA1c [tertiles]: 4.59).
Conclusions/interpretation. Our study suggests that
non-HDL cholesterol and HbA1c are potent predictors
of CHD...