Low LDL Cholesterol and Diabetes Risk
A recent longitudinal study has found a strong inverse association between plasma low-density lipoprotein cholesterol (LDL-C) levels and the development of type 2 diabetes (T2D). Researchers observed that individuals with the lowest LDL-C (<84 mg/dL) had the highest risk of developing T2D over a median follow-up of nearly six years. The findings suggest that low LDL-C may serve as a potential biomarker for identifying individuals at heightened risk of diabetes in the general population.
Impact of Statin Therapy on Type 2 Diabetes
The study also evaluated the modifying effects of statin therapy on the relationship between LDL-C and T2D risk. Among 13,674 participants free of T2D and cardiovascular disease at baseline, 52% were on statins. While statin use slightly increased diabetes risk in individuals with very high LDL-C (≥131 mg/dL), it did not significantly alter risk in the low, medium, or high LDL-C groups. This indicates that the association between low LDL-C and incident T2D is largely independent of statin therapy.
Population-Based Study Highlights LDL-C as Biomarker
Researchers applied Cox proportional hazards models to a population-based cohort of 202,545 individuals. During the follow-up, 1,819 participants (13%) developed T2D. Stratification by LDL-C quartiles revealed a consistent inverse relationship, underscoring the potential of LDL-C as a predictive biomarker for T2D susceptibility, beyond its established role in cardiovascular risk assessment.
Clinical Implications for Monitoring and Prevention
These findings have important clinical implications. Physicians may need to consider monitoring patients with low LDL-C for early signs of glucose dysregulation, even in the absence of statin therapy. Integrating LDL-C measurements with other metabolic risk factors could improve early identification of individuals at risk for T2D, allowing for timely preventive interventions and lifestyle modifications.
Reference
Lembo M et al. A six-year longitudinal study identifies a statin-independent association between low LDL-cholesterol and risk of type 2 diabetes. Cardiovasc Diabetol. 2025;24(1):429.
