Introduction: High density lipoprotein (HDL) exists as multiple subpopulations. HDL subpopulations were measured using the Boston Heart (BH) HDL Map. Low levels of large, α-1 HDL particles (α-1) are associated with adverse cardiovascular outcomes. Low HDL-C, high triglycerides (Tg), high Tg/HDL-c ratio and low large HDL particles measured by other methodologies are associated with Diabetes Mellitus (DM). It is unknown if the prevalence of DM in men and women in a large cohort is related to α-1 levels measured by this methodology and whether this association differs by gender as demonstrated in the Tg/HDL-C ratio.
Methods: A retrospective cohort of 55,765 samples (ages 18 - 80) was developed from patients who received testing at BH. Test results were stratified by gender and split into quartiles. Odds ratios were calculated between each quartile and the first quartile. Area under the curve (AUC) were calculated from age-controlled logistic regression models.
Results: DM prevalence decreased between Q1 (27.1%) and Q4 (10.8%) of α-1 in men. In women, the decrease was more dramatic: 22.0% for Q1 and 4.5% for Q4. The magnitude of the Q4 odds ratios for α-1 (M: 0.33; F: 0.17) was comparable to Tg/HDL-C (M: 3.95; F: 9.7), Tg (M: 3.18; F: 7.95), and HDL-C (M: 0.26; F: 0.15), but larger than apoA-1 (M: 0.43; F: 0.32). The AUC for α-1 was greater for women (0.74) than for men (0.69) and showed similar performance to Tg/HDL-C.
Conclusions: Utilizing the HDL Map, this study shows for the first time that α-1 levels are inversely related to DM prevalence in men; however, the α-1 levels were more inversely related to DM in women. The association between α-1 is greater than apoA-1, but less than the Tg/HDL-C ratio.