Low HDL Cholesterol and the Risk of Diabetic Nephropathy and Retinopathy: Results of the ADVANCE study

Date of this Version


Document Type

Journal Article

Publication Details

Citation only

Morton, J., Zoungas, S., Li, Q., Patel, A. A., Chalmers, J., Woodward, M., Celermajer, D.S., Beulens, J.L., Stolk, R.P., Glasziou, P.,& Ng, M. K. C. (2012). Low HDL cholesterol and the risk of diabetic nephropathy and retinopathy: Results of the advance study. Diabetes Care, 35(11), 2201-2206.

Access the journal

© American Diabetes Association

NHMRC Project Grant GNT0527500




Although low HDL cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and the risk of microvascular disease are limited. We tested the association between HDL-C and microvascular disease in a cohort of patients with type 2 diabetes. A total of 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazards models were used to assess the association between baseline HDL-C and the development of new or worsening microvascular disease, defined prospectively as a composite of renal and retinal events. The mean baseline HDL-C level was 1.3 mmol/L (SD 0.45 mmol/L [range 0.1-4.0]). During follow-up, 32% of patients developed new or worsening microvascular disease, with 28% experiencing a renal event and 6% a retinal event. Compared with patients in the highest third, those in the lowest third had a 17% higher risk of microvascular disease (adjusted hazard ratio 1.17 [95% CI 1.06-1.28], P = 0.001) after adjustment for potential confounders and regression dilution. This was driven by a 19% higher risk of renal events (1.19 [1.08-1.32], P = 0.0005). There was no association between thirds of HDL-C and retinal events (1.01 [0.82-1.25], P = 0.9). In patients with type 2 diabetes, HDL-C level is an independent risk factor for the development of microvascular disease affecting the kidney but not the retina.

This document is currently not available here.



This document has been peer reviewed.