Association between plasma triglycerides and HDL-cholesterol and microvascular kidney disease and retinopathy in type 2 diabetes: a global case-control study in 13 countries.

BACKGROUND: Microvascular renal and retinal diseases are common major complications of type 2 diabetes. The relation between plasma lipids and microvascular disease is not well established.METHODS AND RESULTS: The cases were 2535 patients with type 2 diabetes with average duration 14 years, 1891 having kidney disease and 1218 retinopathy. The cases were matched for diabetes duration, age, sex, and LDL-cholesterol to 3683 controls with type 2 diabetes who did not have kidney disease or retinopathy. The study was conducted in 24 sites in 13 countries. The primary analysis included kidney disease and retinopathy cases. Matched analysis was performed using site-specific conditional logistic regression in multivariable models that adjusted for hemoglobinA1C, hypertension, and statin treatment. Mean LDL-cholesterol concentration was 2.3mmol/L. The microvascular disease odds ratio (OR) increased by a factor of 1.16 (95% CI: 1.11,1.22) for every 0.5mmol/L (approximately 1 quintile) increase in triglycerides; or decreased by a factor of 0.92 (0.88, 0.96) for every 0.2mmol/L (approximately 1 quintile) increase in HDL-cholesterol. For kidney disease, the OR increased by 1.23 (1.16,1.31) with triglycerides and decreased by 0.86 (0.82, 0.91) with HDL-cholesterol. Retinopathy was associated with triglycerides and HDL-cholesterol in matched analysis but not significantly after additional adjustment.CONCLUSIONS: Diabetic kidney disease is associated worldwide with higher levels of plasma triglycerides and lower levels of HDL-cholesterol among patients with good control of LDL-cholesterol. Retinopathy was less robustly associated with these lipids. These results strengthen the rationale for studying dyslipidemia treatment to prevent diabetic microvascular disease.