The Association of High-Density Lipoprotein Cholesterol with Cancer Incidence in Type II Diabetes: A Case of Reverse Causality?

J. Morton, M. K. C. Ng, J. Chalmers, M. Woodward, G. Mancia, N. R. Poulter, M. Marre, M. E. Cooper, S. Zoungas
2013 Cancer Epidemiology, Biomarkers and Prevention  
Low high-density lipoprotein cholesterol (HDL-C) and type II diabetes are associated with an increased risk for cancer. Patients with type II diabetes typically have low HDL-C; however, the association between HDL-C and cancer has not been examined in this population. Methods: A total of 11,140 patients with type II diabetes were followed for a median of 5 years. Cox proportional hazard models were used to assess the association between baseline HDL-C and risk of cancer incidence and cancer
more » ... h, with adjustments made for potential confounders. To explore the possibility of reverse causation, analyses were repeated for the cancers occurring in the first and second halves of follow-up. Results: Six hundred and ninety-nine patients developed cancer, with 48% occurring within the first half of follow-up. For every 0.4 mmol/L lower baseline HDL-C, there was a 16% higher risk of cancer [HR 1.16; 95% confidence interval (CI), 1.06-1.28; P ¼ 0.0008] and cancer death (HR 1.16; 95% CI, 1.01-1.32; P ¼ 0.03). After adjustment for confounding, the higher risk remained significant for cancer (adjusted HR 1.10; 95% CI, 1.00-1.22; P ¼ 0.05) but not for cancer death (adjusted HR 1.08; 95% CI, 0.93-1.25; P ¼ 0.31). The association was driven by cancers occurring within the first half of follow-up (adjusted HR 1.22; 95% CI, 1.05-1.41; P ¼ 0.008) as no significant association was found between HDL-C and cancer in the second half of follow-up.
doi:10.1158/1055-9965.epi-13-0149 pmid:23780837 fatcat:banab7rjrzbuteuhktsbyw32xu