PLASMA-LIPOPROTEINS AND THE INCIDENCE OF ABNORMAL EXCRETION OF ALBUMIN IN DIABETIC AMERICAN-INDIANS - THE STRONG HEART-STUDY

Animal studies suggest that lipids are risk factors for kidney disease s. Some prospective studies and clinical trials have reported predicti ve effects of lipoproteins on different stages of diabetic nephropathy in humans. We examined lipoprotein abnormalities to determine if they predict abnormal urinary excretion of albumin (greater than or equal to 30 mg albumin/g creatinine), using logistic regression. We followed 671 American Indians (211 men, 460 women) with Type II diabetes for a mean of 3.9 years (range 1.7-6.2). Participants were aged 45-74 years . They had normal excretion of albumin and normal serum creatinine at baseline. 67 men and 144 women developed abnormal excretion of albumin . In models controlled for age, treatment with oral hypoglycaemic agen ts or insulin, HbA(1c), study site, degree of Indian heritage, mean ar terial blood pressure, albumin excretion at baseline and duration of d iabetes, a high HDL cholesterol was a protector for abnormal excretion of albumin in women [odds ratio (OR) comparing the 90th with the 10th percentile = 0.56, 95% confidence interval (CI) = 0.32-0.98], but not in men (OR = 1.5, 95% CI = 0.66-3.4). Further adjustment for obesity, insulin concentration, alcohol consumption or physical activity did n ot change the results. There was a tendency for high values of VLDL an d total triglyceride and small LDL size to predict abnormal excretion of albumin in women only. We conclude that low HDL cholesterol was a r isk factor for abnormal excretion of albumin in women, but not in men. Sex hormones may be responsible for sex differences in the associatio n between HDL cholesterol and abnormal excretion of albumin.