The association between the apolipoprotein A1/ high density lipoprotein -cholesterol and diabetes in Taiwan — a cross-sectional study

Abstract

BackgroundTraditional lipid indices have been associated with type 2 diabetes, but it remains uncertain which lipid index is the best discriminator for diabetes. In this study, we aimed to assess lipoproteins, traditional lipid variables, and other variables to discover their association with diabetes in the Taiwanese population.MethodsData from a nationwide cross-sectional population-based survey of 3087 men and 3373 women in 2002 were analyzed in this study. All participants were assessed for anthropometry, glycosylated hemoglobin, fasting sugar and lipid profiles with triglycerides, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), and apolipoprotein A1 (ApoA1) and B (ApoB). The ratio of LDL-C/HDL-C, ApoB/ApoA1, ApoB/LDL-C and ApoA1/HDL-C and other variables were analyzed to determine their potential roles in type 2 diabetes in the Taiwanese population. The Odds ratios (ORs) of the risk variables for diabetes were estimated using logistic regression and were adjusted for confounding factors.ResultsThe increased ratio of ApoA1/HDL-C was significantly associated with diabetes in men (top tertile vs. lowest: OR 2.98; 95% CI: 1.12 - 7.92; P-trend = 0.030) and women (top tertile vs. lowest: OR 2.15; 95% CI: 1.00 - 4.59; P-trend = 0.047). A modest increased diabetic risk was evident with ApoB/LDL-C in women (top tertile vs. lowest: OR 2.03; 95% CI: 1.07- 3.85; P-trend = 0.028), but not in men (top tertile v. lowest: OR 1.69; 95% CI: 0.79- 3.62; P-trend = 0.198).ConclusionsApoA1/HDL-C had a significant linear association with diabetes in both sexes and was superior to other lipid and lipoprotein variables among the general Taiwanese population.

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“…The association of apoB with incident T2DM has been proven with improved risk prediction compared to LDL-c or HDL-c 17 . Increased glycation of apoB corroborated with the finding that the presence of small dense LDL with persistent hyperglycemia increases susceptibility of LDL to undergo glycation.…”

“…In pre-diabetic patients, reduced HDL-c has been reported to be associated with progression to T2DM 17 . Elevated plasma LDL-c and triacylglycerol, and reduced HDL-cholesterol contribute to accelerate atherogenesis in T2DM 20 .…”

“…High ApoA-1 levels independently predicted incident type-2 diabetes among a sample of Turkish participants and the top tertile of serum ApoA-1 level nearly doubled the risk for incident diabetes when compared with the low tertile. Beneficial HDL can be degenerated to a dysfunctional HDL with pro-atherosclerotic and pro-inflammatory properties using oxidation and glycation 17 . HDLs and apoA-1 increase insulin synthesis and secretion in pancreatic β cells 19 .…”

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“…HDLs increase insulin synthesis and secretion in pancreatic β cells 12 . In pre-diabetic patients, reduced HDL-c has been reported to be associated with progression to T2DM 10 . Elevated plasma LDL-c and triacylglycerol, and reduced HDL-cholesterol contribute to accelerate atherogenesis in T2DM 13 .…”

“…The presence of small dense LDL with persistent hyperglycemia increases susceptibility of LDL to undergo glycation. Beneficial HDL can be degenerated to a dysfunctional HDL with pro-atherosclerotic and pro-inflammatory properties using oxidation and glycation 10 . The athero-protective properties of HDL that have been an area of active research include its anti-oxidant, anti-inflammatory, and antithrombotic role.…”