Low HDL Cholesterol and the Risk of Diabetic Nephropathy and Retinopathy Results of the ADVANCE study
Jamie Morton,Jamie Morton,Sophia Zoungas,Sophia Zoungas,Qiang Li,Anushka Patel,John Chalmers,Mark Woodward,David S. Celermajer,David S. Celermajer,David S. Celermajer,Joline W.J. Beulens,Ronald P. Stolk,Ronald P. Stolk,Paul Glasziou,Martin K.C. Ng,Martin K.C. Ng,Martin K.C. Ng +17 more
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TLDR
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.Abstract:
OBJECTIVE 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. RESEARCH DESIGN AND METHODS 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. RESULTS 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). CONCLUSIONS 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.read more
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Markers of and Risk Factors for the Development and Progression of Diabetic Kidney Disease
TL;DR: This review summarizes the evidence regarding the prognostic value and benefits of targeting established and novel risk markers for DKD development and progression and suggests that predictive accuracy often may be increased with greater attention to established markers.
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TL;DR: With increasing understanding of the underlying pathophysiological processes implicated in diabetic nephropathy, new specific renoprotective treatment strategies are anticipated to become available over the next few years.
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Oxidative stress: implications for the development of diabetic retinopathy and antioxidant therapeutic perspectives
TL;DR: New strategies that utilize antioxidants as additive therapy should be implemented in the treatment of DR, as increasing amounts of data have demonstrated the promising prospect of antioxidant therapy and its beneficial effects in vision protection.
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The Evolving Understanding of the Contribution of Lipid Metabolism to Diabetic Kidney Disease
TL;DR: Enhanced fatty acid oxidation in the kidney induced by fenofibrate, a peroxisomal proliferator-activated receptor (PPAR)-α agonist, showed benefit in mouse models of CKD, suggesting that further understanding of lipid metabolism in diabetic kidney disease may lead to novel therapeutic approaches.
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Low levels of high-density lipoprotein cholesterol increase the risk of incident kidney disease and its progression.
TL;DR: A significant association exists between low HDL-C levels and risks of incident CKD and CKD progression, and further studies are needed to explain the increased risk of adverse renal outcomes in patients with high HDL- C.
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Emily Y. Chew,Walter T. Ambrosius,Matthew D. Davis,Ronald P. Danis,Sapna Gangaputra,Craig M. Greven,Larry D. Hubbard,Barbara Esser,James Lovato,Letitia H Perdue,David C. Goff,William C. Cushman,Henry N. Ginsberg,Marshall B. Elam,Saul Genuth,Hertzel C. Gerstein,Ulrich K. Schubart,Lawrence J. Fine +17 more
TL;DR: Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy.
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