title: Utility of non-high-density lipoprotein cholesterol in assessing incident type 2 diabetes risk.
abstract: OBJECTIVE
  Traditional lipid indices have been associated with type 2 diabetes, but limited data are available regarding non-high-density lipoprotein (non-HDL) cholesterol. In view of recent guidelines for the clinical management of dyslipidemia recommending the monitoring of non-HDL cholesterol as a secondary target after achieving the low-density lipoprotein (LDL) cholesterol goal, we aimed to assess the association of non-HDL cholesterol with incident type 2 diabetes and compare its utility as a risk predictor with traditional lipid variables in Aboriginal Canadians.
  
  
  METHODS
  Of 606 diabetes-free participants at baseline, 540 (89.1%) returned for 10-year follow-up assessments. Baseline anthropometry, blood pressure, fasting insulin and serum lipids were measured. Fasting and 2-h postload glucose were obtained at baseline and follow-up to determine the incidence of type 2 diabetes.
  
  
  RESULTS
  The cumulative incidence of type 2 diabetes was 17.5%. Higher non-HDL cholesterol, total-to-HDL cholesterol ratio, apolipoprotein B, triglyceride and LDL cholesterol and lower HDL cholesterol concentrations were individually associated with incident type 2 diabetes in univariate analyses (all p < 0.05). Non-HDL cholesterol was a superior determinant of incident diabetes compared with LDL cholesterol (comparing C-statistics of univariate models p = 0.01) or HDL cholesterol (p = 0.004). With multivariate adjustment including waist circumference, non-HDL cholesterol remained associated with incident diabetes [odds ratio (OR) 1.42 (95% confidence interval, CI 1.07-1.88)], while LDL cholesterol and HDL cholesterol became non-significant.
  
  
  CONCLUSIONS
  Non-HDL cholesterol was associated with incident type 2 diabetes and was superior to LDL cholesterol as a risk predictor in this population. Further studies are required to establish the utility of non-HDL cholesterol in non-Aboriginal populations.
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
authors.forename: S H
authors.initials: SH
authors.lastname: Ley
authors.forename: S B
authors.initials: SB
authors.lastname: Harris
authors.forename: P W
authors.initials: PW
authors.lastname: Connelly
authors.forename: M
authors.initials: M
authors.lastname: Mamakeesick
authors.forename: J
authors.initials: J
authors.lastname: Gittelsohn
authors.forename: T M
authors.initials: TM
authors.lastname: Wolever
authors.forename: R A
authors.initials: RA
authors.lastname: Hegele
authors.forename: B
authors.initials: B
authors.lastname: Zinman
authors.forename: A J
authors.initials: AJ
authors.lastname: Hanley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000517:prevention & control*; D050171:Dyslipidemias / Q000175:diagnosis / Q000208:ethnology; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D055815:Young Adult
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL