title: LDL-cholesterol versus non-HDL-to-HDL-cholesterol ratio and risk for coronary heart disease in type 2 diabetes.
abstract: OBJECTIVE
  We assessed the association between different blood lipid measures and risk of fatal/nonfatal coronary heart disease (CHD), which has been less analysed previously in type 2 diabetes.
  Observational study of 46,786 patients with type 2 diabetes, aged 30-70 years, from the Swedish National Diabetes Register, followed for a mean of 5.8 years until 2009. Baseline and updated mean low-density lipoprotein (LDL)-, high-density lipoprotein (HDL)-, non-HDL-cholesterol, and non-HDL-to-HDL-cholesterol ratio were measured.
  
  
  RESULTS
  Hazard ratios (HR) for CHD with quartiles 2-4 of baseline lipid measures, with lowest quartile 1 as reference: 1.03-1.29-1.63 for LDL; 1.23-1.41-1.95 for non-HDL; 1.29-1.39-1.57 for HDL; and 1.31-1.67-2.01 for non-HDL:HDL, all p < 0.001 except for quartile 2 of LDL, when adjusted for clinical characteristics and nonlipid risk factors. A similar picture was seen with updated mean values. Splines with absolute 6-year CHD rates in a Cox model showed decreasing rates only down to around 3 mmol/l for LDL, with linearly decreasing rates to the lowest level of non-HDL:HDL. Non-HDL and HDL were independent additive risk factors for CHD risk. HRs per 1 SD continuous decrease in baseline or updated mean HDL were 1.14-1.17 when fully adjusted as above, and 1.08-1.13 when also adjusted for non-HDL (p < 0.001). HRs were 1.13-1.16 adjusted for LDL, and 1.22-1.26 adjusted for total cholesterol and triglycerides (p < 0.001). Splines showed progressively increasing 6-year CHD rates with lower HDL down to 0.5 mmol/l.
  
  
  CONCLUSIONS
  This study suggests that lower levels of non-HDL:HDL are a better risk marker for CHD than LDL-cholesterol below 3 mmol/l.
authors.affiliation: Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Eliasson
authors.affiliation: Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Gudbjörnsdottir
authors.affiliation: Department of Public Health and Caring Sciences / Geriatrics, Uppsala University, Sweden bjorn.eliasson@gu.se.
authors.forename: B
authors.initials: B
authors.lastname: Zethelius
authors.affiliation: Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Eeg-Olofsson
authors.affiliation: Department of Public Health and Caring Sciences / Family Medicine and Preventive Mecicine, Uppsala University, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Cederholm
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL
keywords: Diabetes mellitus; LDL-cholesterol; coronary heart disease; epidemiology; human; lipoproteins; non-HDL-cholesterol