J Clin Endocrinol Metab. 2025 Apr 3:dgaf215. doi: 10.1210/clinem/dgaf215. Online ahead of print.
ABSTRACT
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a major driver of coronary atherosclerosis progression, yet its impact is highly heterogeneous. Insulin resistance contributes to a complex interplay of metabolic disturbances that accelerate atherogenesis to varying degrees. Identifying biomarkers that refine cardiovascular risk prediction in this population remains a clinical priority.
OBJECTIVE: To evaluate the association between small HDL particle concentration and the incidence/progression of coronary artery calcium (CAC) in individuals with T2DM.
METHODS: We analyzed 4,331 participants from the ELSA-Brasil cohort. CAC incidence/progression was compared between individuals with and without T2DM. A subgroup of 461 non-statin users with T2DM and no baseline atherosclerotic cardiovascular disease (ASCVD) was further assessed for associations between small HDL particles (<8nm, HDLp1) and CAC outcomes.
RESULTS: Individuals with T2DM showed increased CAC incidence/progression rates compared to non-diabetic participants. Among 461 non-statin users with T2DM, 143 (31.0%) experienced CAC incidence/progression. Higher plasma concentrations of HDLp1 (3rd tertile) were associated with a 140% (95%CI 32-341%, p<0.001) greater likelihood of CAC incidence/progression compared to the 1st tertile. The inclusion of HDLp1 significantly improved CAC risk classification, with a net reclassification improvement (NRI) of 13.6% (95%CI 2.8-18.8%, p=0.004).
CONCLUSION: HDLp1 concentration is significantly associated with CAC incidence/progression in individuals with T2DM and may improve risk discrimination for coronary atherosclerosis progression in this population.
PMID:40177741 | DOI:10.1210/clinem/dgaf215