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Background  The magnitude and direction of association of low-density lipid cholesterol (LDL-C) with diabetes mellitus (DM) might differ by hypertensive status, but there is limited epidemiological evidence in China.    Methods  We examined the association between LDL-C levels and DM in 9892 participants with hypertension using logistic regression. Participants were stratified into three groups according to LDL-C levels (desirable, borderline high or high), then further divided into quartiles. Restricted cubic spline regression models, subgroup analysis and interaction tests were also conducted to evaluate the shape of association.    Results  After adjusting for covariates, lower LDL-C had a significant and inverse association with the likelihood of DM in all participants (OR: 0.944, 95% CI = 0.893, 0.998). In participants with desirable LDL-C concentrations (< 3.4 mmol/L), LDL-C protected against DM (OR = 1.240, 95% CI = 1.076, 1.429 per 1 mmol/L decrease). In participants with higher LDL-C concentrations (> 4.1 mmol/L), LDL-C increased the DM likelihood (OR = 1.536, 95% CI = 1.126, 2.096 per 1 mmol/L increase). Restricted cubic spline regression also found a U-shaped association between LDL-C levels and DM prevalence.    Conclusions  There was a U-shaped association between LDL-C levels and DM in Chinese patients with hypertension.    Electronic supplementary material  The online version of this article (10.1186/s12944-019-1105-5) contains supplementary material, which is available to authorized users.

U-shaped association between low-density lipid cholesterol and diabetes mellitus in patients with hypertension