Key result
Higher small HDL particle levels linked to ~140% greater risk of CAC progression.
Why the study?
Are higher plasma levels of small HDL particles associated with increased incidence or progression of coronary artery calcium in adults with T2DM?
Cohort (n=4,331)
Are higher plasma levels of small HDL particles associated with increased incidence or progression of coronary artery calcium in adults with T2DM?
Answers are grounded in this paper and cite their sources.
Higher concentrations of small HDL particles are significantly associated with coronary atherosclerosis progression in individuals with T2DM and improve risk discrimination.
CONTEXT: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
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Teles et al. (2025) conducted a cohort in Type 2 diabetes mellitus (n=4,331). Small high-density lipoprotein (HDL) particle concentration (HDLp1) vs. First tertile of HDLp1 concentration was evaluated on Incidence/progression of coronary artery calcium (CAC) (140% greater likelihood, 95% CI 32%-341%, p=< .001). Higher plasma concentrations of small HDL particles were associated with a 140% greater likelihood of coronary artery calcium incidence or progression.
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