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Prevalence and Determinants of Elevated Apolipoprotein B and Dense Low-Density Lipoprotein in Youths with Type 1 and Type 2 Diabetes

Department of Medicine (J.J.A.), S.M.M.), Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington School of Medicine, Seattle, Washington 98109; Division of Diabetes Translation (G.I.), Centers for Disease Control and Prevention, Atlanta, Georgia 30333; Department of Biostatistical Sciences (B.M.S., J.S.), Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157; Pacific Health Research Institute (W.Y.F.), Honolulu, Hawaii 96813; Department of Epidemiology and Business (E.J.M.-D.), University of South Carolina, Columbia, South Carolina 29208; Department of Preventative Medicine (D.B.P.), University of Southern California, Los Angeles, California 90089; Department of Pediatric Endocrinology (C.P.), Children’s Hospital and Regional Medical Center, Seattle, Washington 98105; Department of Endocrinology (L.D.), Children’s Hospital Medical Center, Cincinnati, Ohio 45229; and Department of Preventative Medicine and Biometrics (D.M.D.), University of Colorado Health Sciences Center, Denver, Colorado 80262

Address all correspondence and requests for reprints to: Santica M. Marcovina, Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, 401 Queen Anne Avenue North, Seattle, Washington 98109. E-mail: smm{at}u.washington.edu.

Objective: The objective of the study was to assess the prevalence and determinants of elevated apolipoprotein B (apoB) and dense low-density lipoprotein (LDL) in United States youth with type 1 or type 2 diabetes.

Methods: We conducted cross-sectional analyses of apoB concentrations, LDL density, and prevalence of elevated apoB levels and dense LDL from the SEARCH for Diabetes in Youth study, a six-center U.S.-based study of youth with diabetes onset younger than 20 years of age (2657 with type 1 and 345 with type 2).

Results: Among youth with type 1 diabetes, 11% had elevated apoB (100 mg/dl, 1.95 mM/liter), 8% had dense LDL (relative flotation rate 0.237), and 12% had elevated LDL-cholesterol (130 mg/dl, 3.36 mM/liter). In contrast, among youth with type 2 diabetes, 36% had elevated apoB, 36% had dense LDL, but only 23% had elevated LDL-cholesterol. Dense LDL and apoB each increased with hemoglobin A1c in both types. Among type 1 diabetics in poor glycemic control (hemoglobin A1c 9.5%), 28% had elevated apoB, and 18% had dense LDL, whereas 72% of poorly controlled type 2 diabetics had elevated apoB and 62% had dense LDL.

Conclusions: In youth with type 1 diabetes, elevated apoB and dense LDL were not highly prevalent, whereas elevated apoB and dense LDL were common lipoprotein abnormalities in youth with type 2 diabetes. The prevalence of these risk factors substantially increased with poor glycemic control in both groups, stressing the importance of achieving and maintaining an optimal glucose control.

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