HDL-C criterion of the metabolic syndrome and future diabetes and atherosclerosis in midlife women: The SWAN Study

• Published in: American journal of preventive cardiology Vol. 19; p. 100687
• Main Authors: Wang, Ziyuan, Barinas-Mitchell, Emma, Brooks, Maria M., Crawford, Sybil L., Leis, Aleda M., Derby, Carol A., Thurston, Rebecca C., Hedderson, Monique M., Janssen, Imke, Jackson, Elizabeth A., McConnell, Daniel S., El Khoudary, Samar R.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2024; Elsevier
• Subjects: Diabetes; HDL-C; Metabolic syndrome; Subclinical atherosclerosis; HDL-C; Subclinical atherosclerosis; Diabetes; Metabolic syndrome
• ISSN: 2666-6677; 2666-6677
• DOI: 10.1016/j.ajpc.2024.100687

•Midlife women with metabolic syndrome face an increased risk of developing incident diabetes and exhibit higher levels of subclinical measures of atherosclerosis independent of their HDL-C status.•HDL-C classification contributes significantly to risk prediction of incident diabetes, beyond levels of other metabolic syndrome components in midlife women.•Our findings underscored differential contributions of HDL-C in risk prediction for MetS on incident diabetes and subclinical atherosclerosis measures.•Our results emphasized the importance of understanding the association between different components of metabolic syndrome and the risk of developing cardiometabolic events in midlife women, due to the high prevalence of metabolic syndrome in this population.•Our findings also highlight the necessity of controlling for HDL-C levels as a primordial prevention strategy for midlife women at alleviated risk of developing future diabetes. High-density lipoprotein cholesterol (HDL-C) is one of 5 components [high blood pressure, glucose, triglycerides, waist circumference, low HDL-C], 3 of which, needed to diagnose metabolic syndrome (MetS). Evolving research shows that higher HDL-C is not necessarily cardioprotective in midlife women, supporting a need to re-evaluate HDL-C's contribution to risks related to MetS. We tested whether risk of future diabetes and higher carotid intima-media thickness (cIMT) differ by HDL-C status in midlife women diagnosed with MetS based on the other 4 components. 1) no MetS, 2) MetS with HDL-C ≥ 50 mg/dL (MetS hiHDL), and 3) MetS with HDL-C < 50 mg/dL (MetS loHDL). cIMT was measured 13.8 ± 0.6 years post baseline. Incident diabetes was assessed yearly. Among 2773 women (1350 (48 %) of them had cIMT), 2383 (86 %) had no MetS, 117 (4 %) had MetS hiHDL, 273 (10 %) had MetS loHDL. Compared with no MetS, both MetS- hiHDL and loHDL groups had higher cIMT and diabetes risk. Risk of having high cIMT did not differ between MetS loHDL vs. hiHDL groups. Adjusting for levels of MetS criteria other than HDL-C at baseline explained the associations of each of the two MetS groups with cIMT. Conversely, after adjustment, associations of MetS hiHDL and MetS loHDL with incident diabetes persisted. In midlife women, HDL-C status matters for predicting risk of incident diabetes but not higher cIMT beyond other MetS components. [Display omitted]