Association between familial hypercholesterolemia and prevalence of type 2 diabetes mellitus

Kevin Shores, PharmD candidate 2015, Mercer University College of Pharmacy

Familial hypercholesterolemia and type 2 diabetes are two chronic disease states that affect tens of millions of Americans.1,2 There are numerous guidelines and treatment protocols for treating each condition, and while some believe there is a correlation between the two, no definitive proof has been found.3

A recently published study attempted to ascertain an association between familial hypercholesterolemia and type 2 diabetes prevalence.4

Title: Association between familial hypercholesterolemia and prevalence of type 2 diabetes mellitus
Design Observational study in patients with familial hypercholesterolemia and unaffected relatives; 63,385 participants
Objective To assess the association between type 2 diabetes prevalence and familial hypercholesterolemia
Study Groups Group 1: Patients with a familial hypercholesterolemia mutation

Group 2: Unaffected relatives of patients with a familial hypercholesterolemia mutation

Methods The source population was extracted from the familial hypercholesterolemia screening program registry in the Netherlands to identify all domestic patients with familial hypercholesterolemia. Patients both with and without a mutation causing familial hypercholesterolemia were included.
Duration January 1994 until January 2014
Primary outcome measure The primary outcome was presence of type 2 diabetes.
Baseline Characteristics Age: Patients with familial hypercholesterolemia – 38; unaffected relatives – 43 (p<0.001)

Male sex: Patients with familial hypercholesterolemia – 47.4%; unaffected relatives – 48% (p=0.13)

Body Mass Index (BMI): Patients with familial hypercholesterolemia – 23.5; unaffected relatives – 24.4 (p<0.001)

Current smoker: Patients with familial hypercholesterolemia – 19.8%; unaffected relatives – 29.4% (p<0.001)

Statin use: Patients with familial hypercholesterolemia – 28.9%; unaffected relatives – 9% (p<0.001)

Results The prevalence of type 2 diabetes

Familial hypercholesterolemia patients – 1.75% (n=440/25,137)

Unaffected relatives – 2.93% (n = 1,119/38,183) (p<.001)

Adverse Events Adverse events reported: N/A
Serious adverse events: N/A
Adverse events that led to trial discontinuation: N/A
Study Author Conclusions The prevalence of type 2 diabetes among patients with familial hypercholesterolemia was significantly lower than among unaffected relatives, with variability by mutation type.

This study was able to provide a large amount of data and shed some light on a possible link between familial hypercholesterolemia and type 2 diabetes. What the research actually appeared to show is a possible link between familial hypercholesterolemia and not getting type 2 diabetes. It will be interesting to see if this changes the common disposition that hypercholesterolemia and diabetes must be related because many people suffer from both conditions. More studies are needed before a concrete association can be made either way, but this clinical trial is expansive enough to warrant further investigation at the very least.

References

  1. “Cholesterol Facts.”Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Oct. 2012. http://www.cdc.gov/cholesterol/facts.htm. Accessed March 12, 2015
  2. “Statistics About Diabetes.”American Diabetes Association. 10 June 2014. http://www.diabetes.org/diabetes-basics/statistics/. Accessed March 12, 2015
  3. Sattar  N, Preiss  D, Murray  HM,  et al.  Statins and risk of incident diabetes. Lancet. 2010;375(9716):735-742.
  4. Besseling, J., Kastelein, J.,, Defesche, J., “Association between familial hypercholesterolemia and prevalence of type 2 diabetes mellitus.”2015;313(10):1029-1036. doi:10.1001/jama.2015.1206.
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