Association between high-density lipoprotein cholesterol and reversion to normoglycemia from prediabetes: an analysis based on data from a retrospective cohort study

Abstract

The available evidence on the connection between high-density lipoprotein cholesterol (HDL-C) levels and the reversion from prediabetes (Pre-DM) to normoglycemia is currently limited. The present research sought to examine the connection between HDL-C levels and the regression from Pre-DM to normoglycemia in a population of Chinese adults. This historical cohort study collected 15,420 Pre-DM patients in China who underwent health screening between 2010 and 2016. The present research used the Cox proportional hazards regression model to investigate the connection between HDL-C levels and reversion from Pre-DM to normoglycemia. The Cox proportional hazards regression model with cubic spline functions and smooth curve fitting was employed to ascertain the nonlinear association between HDL-C and reversion from Pre-DM to normoglycemia. Furthermore, a set of sensitivity analyses and subgroup analyses were employed. Following the adjustment of covariates, the findings revealed a positive connection between HDL-C levels and the likelihood of reversion from Pre-DM to normoglycemia (HR 1.898, 95% CI 1.758-2.048, P < 0.001). Furthermore, there was a non-linear relationship between HDL-C and the reversion from Pre-DM to normoglycemia in both genders, and the inflection point of HDL-C was 1.540 mmol/L in males and 1.620 mmol/L in females. We found a strong positive correlation between HDL-C and the reversion from Pre-DM to normoglycemia on the left of the inflection point (Male: HR 2.783, 95% CI 2.373-3.263; Female: HR 2.217, 95% CI 1.802-2.727). Our sensitivity analysis confirmed the robustness of these findings. Subgroup analyses indicated that patients with SBP < 140 mmHg and ever smoker exhibited a more pronounced correlation between HDL-C levels and the reversion from Pre-DM to normoglycemia. In contrast, a less robust correlation was observed among patients with SBP ≥ 140 mmHg, current and never smokers. This study provides evidence of a positive and nonlinear association between HDL-C levels and the reversion from Pre-DM to normoglycemia in Chinese patients. Implementing intensified intervention measures to control the HDL-C levels of patients with Pre-DM around the inflection point may substantially enhance the likelihood of regression to normoglycemia.

Figure 1

Study population.

Figure 2

Kaplan–Meier event-free survival curve. Kaplan–Meier event-free survival curve. Kaplan–Meier analysis of incident reversion to normoglycemia from Pre-DM based on HDL-C levels quartiles (log-rank, P < 0.001).

Figure 3

(A) The relationship between HDL-C levels and the reversion to normoglycemia from Pre-DM stratified by gender. A non-linear relationship between HDL-C levels and reversion to normoglycemia from Pre-DM was detected in males after adjustment for DBP, SBP, BMI, age, drinking status, family history of diabetes, smoking status, FPG, AST, BUN, ALT, LDL-C, Scr, and TG. (B) The relationship between HDL-C levels and the reversion to normoglycemia from Pre-DM stratified by gender. A non-linear relationship between HDL-C levels and reversion to normoglycemia from Pre-DM was detected in females after adjustment for DBP, SBP, BMI, age, drinking status, family history of diabetes, smoking status, FPG, AST, BUN, ALT, LDL-C, Scr, and TG.