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Aims/Introduction  A low level of high‐density lipoprotein cholesterol ( HDLC ) is a common feature of metabolic syndrome. We have reported that  J apanese– A mericans who share a virtually identical genetic makeup with native  J apanese, but who have lived  W esternized lifestyles for decades, have lower  HDLC  levels and a high prevalence of type 2 diabetes compared with native  J apanese. However, the impact of low  HDLC  level on type 2 diabetes is unclear. The aims of the present study were to evaluate whether serum  HDLC  level was associated with development of type 2 diabetes and if the effect might be modified by lifestyle.    Materials and Methods  We examined 1,133 non‐diabetic  J apanese– A mericans and 1,072 non‐diabetic  J apanese, who underwent the 75‐g oral glucose tolerance test ( OGTT ) and were followed for an average of 8.8 and 7.0 years, respectively. We analyzed whether serum  HDLC  level is a risk factor for development of type 2 diabetes based on the  C ox proportional hazards model.    Results  After adjustment for age and sex, hazard ratios for development of type 2 diabetes per unit of serum  HDLC  level (mmol/L) were 0.292 (95% confidence interval [ CI ] 0.186–0.458,  P  <   0.0001) among  J apanese– A mericans and 0.551 (95%  CI  0.375–0.88,  P  = 0.0023) among native  J apanese. Comparable hazard ratios after further adjustment for category of  OGTT  and body mass index were 0.981 (95%  CI  0.970–0.993,  P  = 0.0018) and 0.991 (95%  CI  0.980–1.002,  P  = 0.112), respectively.    Conclusions   HDLC  level was associated with development of type 2 diabetes in both  J apanese– A mericans and native  J apanese. However, these results suggest that the impact of high‐density lipoprotein on glucose metabolism might be affected by lifestyle.

journal of diabetes investigation

Low high‐density lipoprotein cholesterol level is a significant risk factor for development of type 2 diabetes: Data from the  H awaii– L os  A ngeles– H iroshima study