(HealthDay News) — For patients with type 2 diabetes with low-density lipoprotein cholesterol (LDL-C) levels <2.0 mmol/L, higher high-density lipoprotein cholesterol (HDL-C) is associated with increased risk for cardiovascular events and all-cause mortality, according to a study published online in Diabetes Care.

Shahnam Sharif, MD, from the University Medical Center Utrecht in the Netherlands, and colleagues performed a prospective cohort study of 1,829 patients with type 2 diabetes in the Second Manifestations of ARTerial disease (SMART) cohort. The authors examined the risk of HDL-C on cardiovascular events and all-cause mortality. Analyses were performed in strata of LDL-C levels and lipid-lowering therapy intensity.

The researchers found that during a median follow-up of 7.0 years there were 335 new cardiovascular events and 385 deaths. Plasma HDL-C was not related to cardiovascular events (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.93 to 1.01) or all-cause mortality (HR, 0.99; 95% CI, 0.96 to 1.03). The effect was modified by plasma LDL-C levels: For patients with LDL-C levels <2.0 mmol/L, higher HDL-C was associated with higher risk of all-cause mortality (HR, 1.14; 95% CI, 1.07 to 1.21) and higher risk for cardiovascular events (HR, 1.10; 95% CI, 1.07 to 1.21), compared with patients with LDL-C levels between 2.0 and 2.5 mmol/L or >2.5 mmol/L.

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“Future studies are needed to confirm this finding and investigate the causality,” the authors write.

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  1. Sharif S, van der Graaf Y, Nathoe HM, et al. HDL Cholesterol as a Residual Risk Factor for Vascular Events and All-Cause Mortality in Patients With Type 2 Diabetes. Diabetes Care. doi:10.2337/dc16-0155.