The risk of future
coronary heart disease (CHD) in subjects with diabetes and "metabolic
dyslipidemia" (high
triglyceride [TGs] and low high-density
cholesterol levels) remains a matter of concern. Little is known regarding the risk of CHD for this phenotype with
low-density lipoprotein cholesterol (
LDL-C) levels <100 mg/dl. We analyzed a diabetes cohort of 28,318 members (aged 30 to 90 years) of Kaiser Permanente Northern California during 2002 to 2011 (192,356 person-years [p-y] follow-up), with
LDL-C levels <100 mg/dl and without known CHD. We compared the incidence and hazard ratios (HRs) for CHD events in groups using Cox models: normal
high-density lipoprotein (HDL) and TG (reference; n = 7,278, 25.7%); normal HDL and high TG (≥ 150 mg/dl; n = 4,484,15.8%); low HDL (≤ 50 mg/dl for women and ≤ 40 mg/dl for men) and normal TG (n = 4,048, 14.3%); low HDL and high TG (metabolic
dyslipidemia; n = 12,508, 44%). Patients with metabolic
dyslipidemia had the highest age-adjusted CHD events/1,000 p-y (12.7/1,000 p-y and 19.0/1,000 p-y for women and men, respectively). After multivariate adjustment for age, gender, ethnicity,
hypertension, smoking,
statin use, duration of diabetes, and
hemoglobin A1c, we observed an increased CHD risk in women (HR 1.35, 95% confidence interval 1.14 to 1.60) and men (HR 1.62, 95% confidence interval 1.43 to 1.83) with metabolic
dyslipidemia compared to those with normal HDL and TG. Even in subjects with an
LDL-C <100 mg/dl, presence of metabolic
dyslipidemia in adults with diabetes is associated with an increased risk of CHD. In conclusion, effective CHD prevention strategies are needed for adults with diabetes and metabolic
dyslipidemia.