Is high density lipoprotein cholesterol useful in diagnosis of metabolic syndrome in native Africans with type 2 diabetes?

BACKGROUND: High-density lipoprotein (HDL) hypocholesterolemia predicts metabolic syndrome among Caucasians and is one of the World Health Organization (WHO) diagnostic criteria of the syndrome. Plasma lipid levels are, however, influenced by genetic and environmental factors.

OBJECTIVE: To determine the relationship between HDL cholesterol and metabolic syndrome among native Africans with type 2 diabetes.

METHODS: Indigenous Nigerians with type 2 diabetes (N = 254) aged 35-80 years (mean: 52.0 +/- 11.7 years) with male:female ratio of 1.5:1 were studied prospectively. Outcome measures included anthropometric indices, plasma lipid concentrations, uric acid, microalbuminuria, and predictive values.

RESULTS: Of the 254 diabetic patients, 150 (54.3%) had metabolic syndrome. Dyslipidemia occurred in 184 (72.4%) patients. Of these, 54 (29.4%) had HDL hypocholesterolemia. Mean HDL cholesterol among patients with HDL hypocolesterolemia and those with normocholesterolemia were 32.4 +/- 5.7 mg/dL and 51.3 +/- 9.9 mg/dL, respectively. Prevalence of metabolic syndrome did not differ significantly between the two groups (56% vs 70.4%; P = .08). Linear regression analysis showed no association between HDL cholesterol and metabolic syndrome (r = 0.01; P = .2), body mass index (r = 0.02; P = .4), waist circumference (r = 0.07; P = .42) and microalbuminuria (r = 0.03; P = .8). A positive correlation occurred between HDL cholesterol and triglyceride concentrations (r = 0.6). The sensitivity, specificity, and positive and negative predictive values of HDL hypocholesterolemia in the diagnosis of metabolic syndrome were 25%, 84.6%, 70.4%, and 44%, respectively.

CONCLUSION: High-density lipoprotein cholesterol may not be a reliable diagnostic tool of metabolic syndrome among native Africans with type 2 diabetes.