Plasma Levels of Small HDL Particles Are Associated With Coronary Atherosclerosis Progression in Adults With Diabetes.

Abstract

Type 2 diabetes mellitus (T2DM) is a major driver of coronary atherosclerosis progression, yet its impact is highly heterogeneous. Insulin resistance contributes to a complex interplay of metabolic disturbances that accelerate atherogenesis to varying degrees. Identifying biomarkers that refine cardiovascular risk prediction in this population remains a clinical priority. To evaluate the association between small high-density lipoprotein (HDL) particle concentration and the incidence/progression of coronary artery calcium (CAC) in individuals with T2DM. We analyzed 4331 participants from the ELSA-Brasil cohort. CAC incidence/progression was compared between individuals with and without T2DM. A subgroup of 461 non-statin users with T2DM and no baseline atherosclerotic cardiovascular disease (ASCVD) was further assessed for associations between small HDL particles (<8 nm, HDLp1) and CAC outcomes. Individuals with T2DM showed increased CAC incidence/progression rates compared to nondiabetic participants. Among 461 non-statin users with T2DM, 143 (31.0%) experienced CAC incidence/progression. Higher plasma concentrations of HDLp1 (third tertile) were associated with a 140% (95% CI, 32%-341%; P < .001) greater likelihood of CAC incidence/progression compared to the first tertile. The inclusion of HDLp1 significantly improved CAC risk classification, with a net reclassification improvement (NRI) of 13.6% (95% CI, 2.8%-18.8%; P = .004). HDLp1 concentration is significantly associated with CAC incidence/progression in individuals with T2DM and may improve risk discrimination for coronary atherosclerosis progression in this population.