It's the HDL; the LDL doesn't matter much (for diabetics)

A recent study (it was published last year but they recently made
fulltext access to it free) show for coronary patients:
The influence of (HDL + triglycerides + apolipoprotein A1, and LDL
particle diameter) significantly predicted both atherosclerosis (CAD)
and heart attack.

Once those factors were accounted for, the remaining factor (LDL + TC +
ApoB) didn't significantly predict either CAD or heart attack.

I find the study interesting, but I have to scratch my head. Why on
EARTH would somebody do a study on diabetics and heart attack and NOT
PUT A1C as one of the factors in the factor analysis? They broke their
popultation into Normal / Impaired FG / Diabetic. But they didn't
factor in A1c beyond that. Why not? They must have had the number,
right?

I wish they'd measured inflammation (by CRP or some other marker) as
well.

Adam Becker
(thought: maybe they didn't include the A1c numbers because they were
too despressing.)

===================

http://care.diabetesjournals.org/cgi/content/abstract/28/1/101

Is Atherosclerosis in Diabetes and Impaired Fasting Glucose Driven by
Elevated LDL Cholesterol or by Decreased HDL Cholesterol?

To evaluate the atherogenicity of lipids in coronary patients with
normal fasting glucose (NFG), impaired fasting glucose (IFG), and type
2 diabetes.

RESEARCH DESIGN AND METHODS-Serum lipid values, the presence of
angiographic coronary artery disease (CAD) at baseline, and the
incidence of vascular events over 2.3 years were recorded in 750
consecutive patients undergoing coronary angiography.

RESULTS-Triglycerides significantly (P < 0.001) increased and HDL
cholesterol (P < 0.001) as well as LDL particle diameter (P < 0.001)
significantly decreased from subjects with NFG <5.6 mmol/l (n = 272)
over patients with IFG =5.6 mmol/l (n = 314) to patients with type 2
diabetes (n = 164). Factor analysis revealed two factors in the lipid
profiles of our patients: triglycerides, HDL cholesterol,
apolipoprotein A1, and LDL particle diameter loaded high on an
HDL-related factor, and total cholesterol, LDL cholesterol, and
apolipoprotein B loaded high on an LDL-related factor. In patients with
type 2 diabetes, the HDL-related factor (odds ratio 0.648 [95% CI
0.464-0.904]; P = 0.011), but not the LDL-related factor (0.921
[0.677-1.251]; P = 0.597), was associated with significant coronary
stenoses =50%. Consistently, in the prospective study, the
HDL-related factor (0.708 [0.506-0.990]; P = 0.044), but not the
LDL-related factor (1.362 [0.985-1.883]; P = 0.061), proved
significantly predictive for vascular events in patients with type 2
diabetes.

CONCLUSIONS-The low HDL cholesterol/high triglyceride pattern is
associated with the degree of hyperglycemia. In coronary patients with
type 2 diabetes, this pattern correlates with the prevalence of CAD and
significantly predicts the incidence of vascular events.

.

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