Differences in HDL-cholesterol : apoA-I plus apoA-II ratio and apoE phenotype with albuminuric status in Type I diabetic patients

Aims/hypothesis. To examine whether the HDL-cholesterol:apoA-I + apoA-II ra tio and the epsilon2 allele are related to albuminuria at baseline and whet her they are risk factors for progression of albuminuria in a cohort study of patients with Type I (insulin-dependent) diabetes mellitus. Methods. At baseline, the study cohort comprised 617 patients, aged 15-60 y ears, from seven European diabetic centres of the EURODIAB study. Albumin e xcretion rate, measured in a central laboratory, was categorised as normoal buminuria at 20 mug/min or less, microalbuminuria between 20 and 200 mug/mi n or macroalbuminuria at 200 mug/min or over. Of the 250 patients who were normoalbuminuric at baseline and had follow-up albuminuria measurements, 34 patients were defined as early progressors. Results. At baseline, the mean HDL-cholesterol:apoA-I + apoA-II ratio was l ower in macroalbuminuric patients (0.79, 95% CI:0.74-0.83) compared with no rmoalbuminuric (0.88, 95% CI:0.87-0.90) patients (p = 0.0002, adjusted for age and sex). At follow-up, 34 patients who progressed from normoalbuminuri a to microalbuminuria or macroalbuminuria also had a slightly lower baselin e ratio (0.85, 95% CI:0.80-0.89) than those 216 who remained normoalbuminur ic (0.89, 95% CI:0.87-0.92) (adjusted p = 0.08). Neither of these relations were independent of LDL-cholesterol or fasting triglyceride. There was no association of the epsilon2 allele with albuminuria either at baseline (OR = 1.4, 95% CI:0.7-2.8) or with progression of albuminuria (OR = 0.4, 95% CI :0.1-3.5). Conclusion/interpretation. There is an inverse relation of HDL-cholesterol: apoA-I + apoA-II ratio with albuminuria at baseline. This lower ratio in mi croalbuminuric or macroalbuminuric patients could contribute to the increas ed risk of cardiovascular disease associated with nephropathy. There is wea k evidence that HDL-composition is a risk factor for progression of albumin uria and no association of the epsilon2 allele with diabetic nephropathy.