HDL-Cholesterol and Incident Type 2 Diabetes Mellitus Among African Americans: The Jackson Heart Study

Accruing evidence suggest an association between high-density lipoprotein- cholesterol (HDL-C) and incident diabetes. However, there is a paucity of data on the link between HDL-C and diabetes, especially among African Americans. To assess the association of HDL-C and its fractions with incident type 2 diabetes among African Americans. We included Jackson Heart Study participants who attended visit 1 (2001-2004), were free from diabetes, and were not treated with lipid-modifying medications. Incident diabetes was assessed at two subsequent 4-yearly visits (2 and 3). We cross-sectionally assessed the association of HDL-C and insulin resistance using multivariable linear models. We prospectively assessed the association of HDL-C and its fractions with incident diabetes using multivariable Cox regression models. Among 2,829 participants (mean age: 51.9 ±12.4 years, 63.9% female), 487 individuals (17%) developed new-onset diabetes, over a median follow-up of 8 years. In adjusted models, a higher HDL-C concentration was associated with a lower odds of insulin resistance (OR per SD increment: OR 0.56 [95% CI 0.50-0.63], P