Wang Ziyuan, Barinas-Mitchell Emma, Brooks Maria M, Crawford Sybil L, Leis Aleda M, Derby Carol A, Thurston Rebecca C, Hedderson Monique M, Janssen Imke, Jackson Elizabeth A, McConnell Daniel S, El Khoudary Samar R
Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh PA, USA.
Tan Chingfen Graduate School of Nursing, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Am J Prev Cardiol. 2024 Jun 19;19:100687. doi: 10.1016/j.ajpc.2024.100687. eCollection 2024 Sep.
High-density lipoprotein cholesterol (HDL-C) is one of 5 components [high blood pressure, glucose, triglycerides, waist circumference, low HDL-C], 3 of which, needed to diagnose metabolic syndrome (MetS). Evolving research shows that higher HDL-C is not necessarily cardioprotective in midlife women, supporting a need to re-evaluate HDL-C's contribution to risks related to MetS. We tested whether risk of future diabetes and higher carotid intima-media thickness (cIMT) differ by HDL-C status in midlife women diagnosed with MetS based on the other 4 components.
METHODS MIDLIFE WOMEN WERE CLASSIFIED INTO 3 GROUPS: 1) no MetS, 2) MetS with HDL-C ≥ 50 mg/dL (MetS hiHDL), and 3) MetS with HDL-C < 50 mg/dL (MetS loHDL). cIMT was measured 13.8 ± 0.6 years post baseline. Incident diabetes was assessed yearly.
Among 2773 women (1350 (48 %) of them had cIMT), 2383 (86 %) had no MetS, 117 (4 %) had MetS hiHDL, 273 (10 %) had MetS loHDL. Compared with no MetS, both MetS- hiHDL and loHDL groups had higher cIMT and diabetes risk. Risk of having high cIMT did not differ between MetS loHDL vs. hiHDL groups. Adjusting for levels of MetS criteria other than HDL-C at baseline explained the associations of each of the two MetS groups with cIMT. Conversely, after adjustment, associations of MetS hiHDL and MetS loHDL with incident diabetes persisted.
In midlife women, HDL-C status matters for predicting risk of incident diabetes but not higher cIMT beyond other MetS components.
高密度脂蛋白胆固醇（HDL-C）是用于诊断代谢综合征（MetS）的5项指标[高血压、血糖、甘油三酯、腰围、低HDL-C]之一，其中3项指标用于诊断代谢综合征。不断发展的研究表明，较高的HDL-C对中年女性不一定具有心脏保护作用，这支持了重新评估HDL-C对与MetS相关风险的影响的必要性。我们测试了基于其他4项指标诊断为MetS的中年女性中，未来患糖尿病的风险和较高的颈动脉内膜中层厚度（cIMT）是否因HDL-C水平而异。
中年女性被分为3组：1）无MetS，2）HDL-C≥50mg/dL的MetS（MetS高HDL组），3）HDL-C<50mg/dL的MetS（MetS低HDL组）。在基线后13.8±0.6年测量cIMT。每年评估新发糖尿病情况。
在2773名女性中（其中1350名（48%）有cIMT测量值），2383名（86%）无MetS，117名（4%）有MetS高HDL，273名（10%）有MetS低HDL。与无MetS相比，MetS高HDL组和低HDL组的cIMT和糖尿病风险均更高。MetS低HDL组和高HDL组之间高cIMT的风险没有差异。在基线时对除HDL-C以外的MetS标准水平进行调整后，解释了两个MetS组与cIMT之间的关联。相反，调整后，MetS高HDL组和MetS低HDL组与新发糖尿病之间的关联仍然存在。
在中年女性中，HDL-C水平对于预测新发糖尿病的风险很重要，但对于预测高于其他MetS指标的cIMT则不重要。
