title: Non-HDL cholesterol goal attainment and its relationship with triglyceride concentrations among diabetic subjects with cardiovascular disease: A nationwide survey of 2674 individuals in Hungary.
abstract: OBJECTIVE
  Non-HDL cholesterol represents the pro-atherogenic, apo-B-containing lipoprotein fraction of circulating lipids, and represents a secondary target for CVD prevention in people with diabetes. We therefore assessed the proportion of individuals with diabetes and CVD who attain a non-HDL-C goal of <2.6 mmol/L, the extent to which triglycerides influence this goal attainment, and their relationship with HDL-C and triglyceride-rich lipoproteins (TRL).
  
  
  RESULTS
  Of 2674 diabetic subjects with baseline CVD in the Hungarian MULTI-GAP programme (mean age 64.8 years, mean HbA1c 7.2%), an LDL-C goal <1.8 and non-HDL-C goal <2.6 mmol/L was attained in 13.5% and 17.7% individuals, respectively. Non-HDL-C goal attainment declined at higher triglyceride concentrations; and graphically this relationship appeared to be continuously and inversely associated with triglyceride concentrations. In contrast, the relationship between LDL-C goal attainment was inversely and continuously associated with triglyceride levels up to about 2.5 mmol/L, after which the graphical appearance plateaued such that no further difference in LDL-C were observed beyond triglyceride levels of 2.5 mmol/L. With increasing triglyceride concentrations, non-HDL-C increased continuously, HDL-C decreased initially but later plateaued (at 1.5-2.0 [men] or 2.0-2.5 mmol/L [women]), LDL-C levels plateaued at about 2.0-2.5 mmol/L, and TRL-cholesterol (non-HDL-C minus LDL-C) rose continuously. In multivariable-adjusted models, elevated triglyceride concentrations, non-specialist care and uncontrolled blood pressure were inversely associated with non-HDL-C goal attainment. Triglyceride levels were more strongly associated with non-HDL-C than with LDL-C goal attainment (ORs per 1-SD increase in log-triglycerides was 0.74, 95% CI 0.61-0.89, for LDL-C goal attainment, and 0.49, 95% CI 0.38-0.61, for non-HDL-C goal attainment).
  
  
  CONCLUSIONS
  Non-HDL-C goal attainment was suboptimal in people with diabetes and co-existing CVD. This was most marked at higher triglyceride levels, possibly due to higher levels of TRL.
authors.affiliation: 2nd Department of Medicine - Cardiology, Pandy Kalman Bekes County Hospital, Gyula, Hungary.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Mark
authors.affiliation: Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, UK.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Vallejo-Vaz
authors.affiliation: 4th Department of Medicine, St George Fejer County Hospital, Szekesfehervar, Hungary.
authors.forename: Istvan
authors.initials: I
authors.lastname: Reiber
authors.affiliation: 1st Department of Medicine, Medical and Health Science Centre, University of Debrecen, Debrecen, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Paragh
authors.affiliation: Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, UK.
authors.forename: Sreenivasa Rao
authors.initials: SR
authors.lastname: Kondapally Seshasai
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK. Electronic address: k.ray@imperial.ac.uk.
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D016009:Chi-Square Distribution; D008076:Cholesterol, HDL / Q000097:blood*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006040:Goals; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D000960:Hypolipidemic Agents; D014280:Triglycerides; C517652:hemoglobin A1c protein, human
keywords: Cardiovascular disease; Diabetes mellitus; LDL cholesterol; Non-HDL cholesterol; Remnants; Triglyceride-rich lipoproteins; Triglycerides