High HDL Cholesterol Linked to Increased Kidney Disease Risk in Women with Type 2 Diabetes

المفاهيم الأساسية

Very high and very low levels of HDL cholesterol are associated with a higher risk of kidney disease in women with type 2 diabetes, but not in men.

الملخص

The study examined the relationship between HDL cholesterol (HDL-C) levels and the risk of diabetic kidney disease in 936 patients with type 2 diabetes. The researchers used logistic regression and a restricted cubic spline curve to assess the continuous and categorical associations.

The key findings are:

• A U-shaped association was observed between HDL-C levels and the risk of diabetic kidney disease, with the risk being higher when HDL-C levels were below 0.95 mmol/L or above 1.54 mmol/L.
• Compared to patients with HDL-C levels between 0.95-1.54 mmol/L, those with very high and very low HDL-C levels had a 128% and 77% increased risk of diabetic kidney disease, respectively.
• The association was significant in women (p=0.006) but not in men (p=0.054), after adjusting for confounding factors.
• HDL-C level as a continuous variable was not associated with the risk of kidney disease (p=0.902).

The authors suggest that while HDL-C is generally considered cardioprotective, at very high levels, this protective effect may not hold true and may be associated with an increased risk of diabetic kidney disease.

الإحصائيات

The study included 936 patients with type 2 diabetes, with a mean age of about 60 years. 41% of the participants were women, and 33% had diabetic kidney disease.

اقتباسات

"Although HDL-C is generally considered a cardiovascular protective factor, at very high levels, this protective effect does not seem to hold true and may be associated with an increased DKD [diabetic kidney disease] risk."

الرؤى الأساسية المستخلصة من

HDL Cholesterol Increases Kidney Disease Risk in T2D

by Javed Choudh... في www.medscape.com 07-31-2024

https://www.medscape.com/viewarticle/hdl-cholesterol-increases-kidney-disease-risk-t2d-2024a1000dzs

استفسارات أعمق

What are the potential mechanisms underlying the U-shaped relationship between HDL-C levels and the risk of diabetic kidney disease?

The U-shaped relationship observed between HDL-C levels and the risk of diabetic kidney disease can be attributed to several potential mechanisms. Firstly, very low levels of HDL-C are associated with impaired reverse cholesterol transport, leading to increased inflammation, oxidative stress, and endothelial dysfunction, all of which contribute to the pathogenesis of diabetic kidney disease. On the other hand, very high levels of HDL-C may indicate dysfunctional HDL particles that have lost their protective properties and could potentially promote inflammation and oxidative stress, exacerbating kidney damage. Additionally, abnormal HDL-C levels may disrupt lipid metabolism, impair renal function, and contribute to the development and progression of diabetic kidney disease through various pathways, including altered lipid deposition in the kidneys, increased glomerular permeability, and enhanced renal fibrosis.

How do other factors, such as diet, lifestyle, obesity, and genetic factors, interact with HDL-C levels to influence the risk of diabetic kidney disease?

Various factors, including diet, lifestyle, obesity, and genetic factors, interact with HDL-C levels to influence the risk of diabetic kidney disease. A diet high in saturated fats and refined sugars can lead to dyslipidemia, including low HDL-C levels, which are associated with an increased risk of kidney disease. Sedentary lifestyle and obesity are also linked to dyslipidemia and insulin resistance, further exacerbating the risk of diabetic kidney disease. Genetic factors play a crucial role in determining HDL-C levels and may predispose individuals to abnormalities in lipid metabolism and kidney function, increasing their susceptibility to kidney disease. Moreover, certain genetic diseases can directly impact HDL-C levels and renal health, influencing the overall risk of diabetic kidney disease.

What are the implications of these findings for the management and prevention of diabetic kidney disease, particularly in the context of personalized medicine and targeted interventions?

The findings regarding the U-shaped relationship between HDL-C levels and the risk of diabetic kidney disease have significant implications for the management and prevention of this condition, especially in the context of personalized medicine and targeted interventions. Healthcare providers should consider assessing HDL-C levels in patients with type 2 diabetes to identify individuals at higher risk of diabetic kidney disease based on their HDL-C profile. Personalized treatment strategies can then be tailored to address specific HDL-C abnormalities, such as very low or very high levels, to mitigate the risk of kidney disease. Targeted interventions, including lifestyle modifications, dietary changes, and pharmacological therapies aimed at optimizing HDL-C levels, may help prevent or delay the onset and progression of diabetic kidney disease in at-risk individuals. By incorporating personalized approaches that take into account individual HDL-C profiles and associated risk factors, healthcare providers can improve the management and outcomes of diabetic kidney disease while advancing the field of precision medicine in nephrology.