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HDL2 beats total HDL in predicting coronary artery disease in type 2 diabetics

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WESTPORT, CT (Reuters Health) – Low levels of HDL2 cholesterol might serve as a better predictor of coronary artery disease in type 2 diabetics than does total high-density lipoprotein cholesterol, according to a report in the September/October Journal of Diabetes and Its Complications.

Until now, the authors note, it has been unclear whether the lipid-rich HDL2 fraction, the lipid-poor HDL3 fraction, or both are related to the reduced incidence of CAD in type 2 diabetics.

Dr. Anastasios Kalofoutis and colleagues from the University of Athens School of Medicine analyzed blood samples from 28 type 2 diabetics with CAD, 24 non-diabetic patients with CAD, and 25 healthy controls. Fasting plasma triglycerides were higher among diabetic patients with CAD than among healthy controls (p = 0.001) or CAD patients without diabetes (p <0.05), they found.

CAD patients with type 2 diabetes had low levels of HDL, HDL2, and HDL3, compared with healthy controls, but compared with non-diabetic CAD patients, they had significantly lower concentrations of only HDL and HDL2, not HDL3.

The differences in HDL2 levels showed greater statistical significance than did differences in HDL and HDL3, the results indicate. In fact, the researchers note, reductions of mean plasma HDL2 in diabetic CAD patients were 19 to 28 percentage points greater than HDL and HDL3 reductions compared with healthy controls, and 12 to 17 percentage points greater compared with non-diabetic CAD patients.

"Our data suggest that HDL2 is a more variable fraction, so variations in HDL cholesterol levels may reflect variations rather in HDL2 cholesterol than in HDL3 cholesterol levels," the investigators say.

"Therefore, HDL2 might be a better predictor of coronary heart disease than total HDL in non-insulin-dependent diabetes mellitus," they conclude. "The decrease in total HDL may underestimate the true atherogenic potential associated with the diabetic state."

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