Key result
Normal-moderate increasing non-HDL-C trajectory is linked to ~48% higher risk of incident prediabetes.
Why the study?
The study aimed to identify longitudinal trajectories of non-HDL-C in middle-aged women and examine their associations with incident prediabetes.
Does a rapidly increasing longitudinal trajectory of non-HDL-C increase the risk of incident prediabetes compared to a normal-low increasing trajectory in middle-aged women without baseline diabetes or prediabetes?
Cohort (n=1,213)
No
Does a rapidly increasing longitudinal trajectory of non-HDL-C increase the risk of incident prediabetes compared to a normal-low increasing trajectory in middle-aged women without baseline diabetes or prediabetes?
In middle-aged Chinese women, a rapid longitudinal increase in non-HDL-C (even within the normal range) is independently associated with a 48% higher risk of developing prediabetes, particularly among those aged 45–49 years, highlighting the importance of tracking dynamic lipid trajectories over isolated cross-sectional values.
Answers are grounded in this paper and cite their sources.
Monitoring non-HDL-C trajectories may refine prediabetes risk assessment in middle-aged women; leaves open whether targeting trajectories prevents progression.
Objectives To identify longitudinal trajectories of non-high-density lipoprotein cholesterol (non-HDL-C) in middle-aged women and examine their associations with incident pre-diabetes (PDM). Design A retrospective cohort study. Setting Annual electronic health examination records from a tertiary hospital in Changsha, China, between January 2016 and December 2023. Participants A total of 1213 women aged 45–59 years at baseline, without diabetes or PDM and with at least four health examination records, were included. Outcome measures The outcome was incident PDM. Latent class growth model was applied to identify distinct trajectories of non-HDL-C and Cox proportional hazards models were used to estimate the associations of trajectory classes and absolute non-HDL-C measures with PDM. Results During a mean follow-up of 4.89 years, 401 participants developed PDM, corresponding to an incidence density of 67.63 per 1000 person-years. Three trajectory classes of non-HDL-C were identified: normal-low increasing group (32.8%), normal-moderate increasing group (49.2%) and abnormally high increasing group (18.0%). Compared with the normal-low increasing group, the normal-moderate increasing group had a significantly higher risk of PDM (HR=1.48, p=0.002). Mean non-HDL-C was not significantly associated with PDM (HR per 1 mmol/L increase 1.13, p=0.092). Additional adjustment for baseline non-HDL-C did not materially change the trajectory results. Subgroup analyses revealed a significant interaction only for age (P for interaction=0.042). Among women aged 45–49 years at baseline, the normal-moderate increasing group was associated with a higher risk of PDM than the normal-low increasing group (HR=1.75, p=0.001). Conclusions The non-HDL-C levels in middle-aged women generally exhibited an increasing trend over time. Among the three identified trajectory classes, the class characterised by a more rapid rate of increase was associated with a higher risk of developing PDM, and this association varied by baseline age, with the strongest association observed in the 45–49 year subgroup. These findings highlight the importance of monitoring not only absolute non-HDL-C levels but also its longitudinal trajectory.
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Zhuo et al. (2026) conducted a cohort in Incident prediabetes among middle-aged women (n=1,213). Normal-moderate increasing non-HDL-C trajectory vs. Normal-low increasing non-HDL-C trajectory was evaluated on Incident prediabetes (per 1000 person-years) (HR 1.48, 95% CI 1.16 to 1.90, p=0.002). A normal-moderate increasing non-HDL-C trajectory was associated with a 48% higher risk of incident prediabetes compared with a normal-low increasing trajectory.
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