Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Clin Endocrinol Metab. 2019 Nov 1;104(11):5633-5641. doi: 10.1210/jc.2019-01080.
The bidirectional relationship between low high-density lipoprotein cholesterol (HDL-C) and glucose intolerance is well established. Recent studies suggested an association of lipid variability with various health outcomes.
To investigate the combined effect of HDL-C levels and their variability on the risk of diabetes.
A population-based cohort study.
In all, 5,114,735 adults without known diabetes in the Korean National Health Insurance System cohort who underwent three or more health examinations from 2009 to 2013 were included. Visit-to-visit HDL-C variability was calculated using variability independent of the mean (VIM) and the coefficient of variation (CV). Low mean and high variability groups were defined as the lowest and highest quartiles of HDL-C mean and variability, respectively.
Newly developed diabetes.
There were 122,192 cases (2.4%) of incident diabetes during the median follow-up of 5.1 years. Lower mean or higher variability of HDL-C was associated with higher risk of diabetes in a stepwise manner, and an additive effect of the two measures was noted. In the multivariable-adjusted model, the hazard ratios and 95% CIs for incident diabetes were 1.20 (1.18 to 1.22) in the high mean/high VIM group, 1.35 (1.33 to 1.37) in the low mean/low VIM group, and 1.40 (1.38 to 1.42) in the low mean/high VIM group compared with the high mean/low VIM group. Similar results were observed when modeling the variability using CV and in various subgroup analyses.
Low mean and high variability in HDL-C were independent predictors of diabetes with an additive effect. Both elevating and stabilizing HDL-C may be important goals for reducing diabetes risk.
低高密度脂蛋白胆固醇（HDL-C）和葡萄糖耐量之间的双向关系已得到充分证实。最近的研究表明，脂质变异性与各种健康结果有关。
研究 HDL-C 水平及其变异性对糖尿病风险的综合影响。
基于人群的队列研究。
在韩国国家健康保险系统队列中，共有 5114735 名无已知糖尿病的成年人，他们在 2009 年至 2013 年期间接受了三次或更多次健康检查。采用均值独立变异（VIM）和变异系数（CV）来计算随访间 HDL-C 变异性。低均值和高变异组分别定义为 HDL-C 均值和变异的最低和最高四分位数。
新发糖尿病。
在中位随访 5.1 年期间，共发生 122192 例（2.4%）新发糖尿病。HDL-C 均值较低或变异性较高与糖尿病风险呈逐步相关，两种指标存在相加效应。在多变量调整模型中，高均值/高 VIM 组、低均值/低 VIM 组和低均值/高 VIM 组发生糖尿病的风险比（HR）及 95%可信区间（CI）分别为 1.20（1.18 至 1.22）、1.35（1.33 至 1.37）和 1.40（1.38 至 1.42），与高均值/低 VIM 组相比。当使用 CV 来模拟变异性和在各种亚组分析中时，也观察到了类似的结果。
HDL-C 均值较低和变异性较高是糖尿病的独立预测因素，且具有相加效应。升高和稳定 HDL-C 可能是降低糖尿病风险的重要目标。
