Non-HDL-cholesterol in an adolescent diabetes population

• Published in: Journal of clinical lipidology 2014-03, Vol.8 (2), p.194-198
• Main Authors: Kuryan, Ranita E., MD, Jacobson, Marc S., MD, Frank, Graeme R., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Cardiovascular; Cholesterol - blood; Cholesterol, HDL - blood; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - pathology; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - pathology; Dyslipidemia; Dyslipidemias - blood; Fasting; Female; Humans; Lipids - blood; Male; Non-HDL-cholesterol; Risk Factors
• ISSN: 1933-2874; 1876-4789
• DOI: 10.1016/j.jacl.2013.12.006

Background Screening for dyslipidemia poses some challenges. Nonfasting lipid profiles frequently have elevated triglycerides. In addition, in the standard lipid profile, low-density lipoprotein (LDL) cholesterol is a calculated value rather than a direct measurement and is triglyceride dependent. Non–high-density lipoprotein cholesterol (non-HDL-C) is an alternative method to assess for dyslipidemia and provides a single estimate of all atherogenic apolipoprotein B–containing lipoproteins. Objective To calculate the non-HDL-C in adolescents with diabetes and to evaluate risk factors associated with an elevated non-HDL-C and to compare the prevalence of dyslipidemia, defined by non-HDL-C, with the prevalence of dyslipidemia defined by LDL cholesterol in the SEARCH study. Methods Data were collected from 502 adolescent patients with diabetes and analyzed. Non-HDL-C was calculated and levels were categorized into normal, borderline, and high based on the National Cholesterol Education Program. Results Lipid profile was performed in 370 patients, 92% of whom had type 1 diabetes. In the 339 subjects with type 1 diabetes, mean hemoglobin A1c (HbA1c) of those with normal non-HDL-C (8.6%) was significantly lower than the HbA1c of those with high non-HDL-C (9.6%) ( P  = .005). Subjects with normal non-HDL-C had a lower body mass index (BMI) z-score (0.4 ± 0.8) than the group with borderline and high non-HDL-C (0.75 ± 0.9%), P  = .002. In the 31 subjects with type 2 diabetes, the mean HbA1c of those with normal non-HDL-C (8.1%) and those with borderline non-HDL-C (7.0%) was significantly lower than the mean HbA1c of those with high non-HDL-C (11.8%) ( P  = .04, and P  = .009, respectively). In addition, the subjects with normal non-HDL-C had a lower BMI z-score (1.3 ± 1.3) than the group with borderline and high non-HDL-C (2.2 ± 0.6%), P  = .03. The prevalence of dyslipidemia using non-HDL-C was similar to prevalence rates using LDL-C in the SEARCH study. Conclusions In adolescents with diabetes, non-HDL-C is increased with poorer diabetes control and higher BMI. It appears to be a superior nonfasting lipid screening test for adolescents with diabetes that can be readily calculated on a randomly obtained rather than fasting sample.