Applying the expanding photosphere and standardized candle methods to Type II-Plateau supernovae at cosmologically significant redshifts . The distance to SN 2013eq

Based on optical imaging and spectroscopy of the Type II-Plateau SN 2013eq, we present a comparative study of commonly used distance determination methods based on Type II supernovae. The occurrence of SN 2013eq in the Hubble flow (z = 0.041 ± 0.001) prompted us to investigate the implications of the difference between "angular" and "luminosity" distances within the framework of the expanding photosphere method (EPM) that relies upon a relation between flux and angular size to yield a distance. Following a re-derivation of the basic equations of the EPM for SNe at non-negligible redshifts, we conclude that the EPM results in an angular distance. The observed flux should be converted into the SN rest frame and the angular size, θ, has to be corrected by a factor of (1 + z)2. Alternatively, the EPM angular distance can be converted to a luminosity distance by implementing a modification of the angular size. For SN 2013eq, we find EPM luminosity distances of DL = 151 ± 18 Mpc and DL = 164 ± 20 Mpc by making use of different sets of dilution factors taken from the literature. Application of the standardized candle method for Type II-P SNe results in an independent luminosity distance estimate (DL = 168 ± 16 Mpc) that is consistent with the EPM estimate. Spectra of SN 2013eq are available in the Weizmann Interactive Supernova data REPository (WISeREP): http://wiserep.weizmann.ac.il

Type Ia supernovae from violent mergers of carbon-oxygen white dwarfs: polarization signatures

The violent merger of two carbon-oxygen white dwarfs has been proposed as a viable progenitor for some Type Ia supernovae. However, it has been argued that the strong ejecta asymmetries produced by this model might be inconsistent with the low degree of polarization typically observed in Type Ia supernova explosions. Here, we test this claim by carrying out a spectropolarimetric analysis for the model proposed by Pakmor et al. for an explosion triggered during the merger of a 1.1 and 0.9 M⊙ carbon-oxygen white dwarf binary system. Owing to the asymmetries of the ejecta, the polarization signal varies significantly with viewing angle. We find that polarization levels for observers in the equatorial plane are modest (≲1 per cent) and show clear evidence for a dominant axis, as a consequence of the ejecta symmetry about the orbital plane. In contrast, orientations out of the plane are associated with higher degrees of polarization and departures from a dominant axis. While the particular model studied here gives a good match to highly polarized events such as SN 2004dt, it has difficulties in reproducing the low polarization levels commonly observed in normal Type Ia supernovae. Specifically, we find that significant asymmetries in the element distribution result in a wealth of strong polarization features that are not observed in the majority of currently available spectropolarimetric data of Type Ia supernovae. Future studies will map out the parameter space of the merger scenario to investigate if alternative models can provide better agreement with observations.

The peculiar Type Ia supernova iPTF14atg: Chandrasekhar-mass explosion or violent merger?

iPTF14atg, a subluminous peculiar Type Ia supernova (SN Ia) similar to SN 2002es, is the first SN Ia for which a strong UV flash was observed in the early-time light curves. This has been interpreted as evidence for a single-degenerate (SD) progenitor system, where such a signal is expected from interactions between the SN ejecta and the non-degenerate companion star. Here, we compare synthetic observables of multidimensional state-of-the-art explosion models for different progenitor scenarios to the light curves and spectra of iPTF14atg. From our models, we have difficulties explaining the spectral evolution of iPTF14atg within the SD progenitor channel. In contrast, we find that a violent merger of two carbon-oxygen white dwarfs with 0.9 and 0.76 M⊙, respectively, provides an excellent match to the spectral evolution of iPTF14atg from 10 d before to several weeks after maximum light. Our merger model does not naturally explain the initial UV flash of iPTF14atg. We discuss several possibilities like interactions of the SN ejecta with the circumstellar medium and surface radioactivity from an He-ignited merger that may be able to account for the early UV emission in violent merger models.

Mechanical stretch up-regulates the B-type natriuretic peptide system in human cardiac fibroblasts:a possible defense against transforming growth factor-β mediated fibrosis

BACKGROUND: Mechanical overload of the heart is associated with excessive deposition of extracellular matrix proteins and the development of cardiac fibrosis. This can result in reduced ventricular compliance, diastolic dysfunction, and heart failure. Extracellular matrix synthesis is regulated primarily by cardiac fibroblasts, more specifically, the active myofibroblast. The influence of mechanical stretch on human cardiac fibroblasts' response to pro-fibrotic stimuli, such as transforming growth factor beta (TGFβ), is unknown as is the impact of stretch on B-type natriuretic peptide (BNP) and natriuretic peptide receptor A (NPRA) expression. BNP, acting via NPRA, has been shown to play a role in modulation of cardiac fibrosis.

METHODS AND RESULTS: The effect of cyclical mechanical stretch on TGFβ induction of myofibroblast differentiation in primary human cardiac fibroblasts and whether differences in response to stretch were associated with changes in the natriuretic peptide system were investigated. Cyclical mechanical stretch attenuated the effectiveness of TGFβ in inducing myofibroblast differentiation. This finding was associated with a novel observation that mechanical stretch can increase BNP and NPRA expression in human cardiac fibroblasts, which could have important implications in modulating myocardial fibrosis. Exogenous BNP treatment further reduced the potency of TGFβ on mechanically stretched fibroblasts.

CONCLUSION: We postulate that stretch induced up-regulation of the natriuretic peptide system may contribute to the observed reduction in myofibroblast differentiation.

Long-term statin therapy in patients with systolic heart failure and normal cholesterol:effects on elevated serum markers of collagen turnover, inflammation, and B-type natriuretic peptide

BACKGROUND: The role of statin therapy in heart failure (HF) is unclear. The amino-terminal propeptide of procollagen type III (PIIINP) predicts outcome in HF, and yet there are conflicting reports of statin therapy effects on PIIINP.

OBJECTIVES: This study determined whether there was an increase in serum markers of inflammation, fibrosis (including PIIINP), and B-type natriuretic peptide (BNP) in patients with systolic HF and normal total cholesterol and determined the effects of long-term treatment with atorvastatin on these markers.

METHODS: Fifty-six white patients with systolic HF and normal cholesterol levels (age 72 [13] years; 68% male; body mass index 27.0 [7.3] kg/m(2); ejection fraction 35 [13]%; 46% with history of smoking) were randomly allocated to atorvastatin treatment for 6 months, titrated to 40 mg/d (A group) or not (C group). Age- and/or sex-matched subjects without HF (N group) were also recruited. Biomarkers were measured at baseline (all groups) and 6 months (A and C groups).

RESULTS: Serum markers of collagen turnover, inflammation, and BNP were significantly elevated in HF patients compared with normal participants (all P < 0.05). There were correlations between these markers in HF patients but not in normal subjects. Atorvastatin treatment for 6 months caused a significant reduction in the following biomarkers compared with baseline: BNP, from median (interquartile range) 268 (190-441) pg/mL to 185 (144-344) pg/mL; high-sensitivity C-reactive protein (hs-CRP), from 5.26 (1.95 -9.29) mg/L to 3.70 (2.34-6.81) mg/L; and PIIINP, from 4.65 (1.86) to 4.09 (1.25) pg/mL (all P < 0.05 baseline vs 6 months). Between-group differences were significant for PIIINP only (P = 0.027). There was a positive interaction between atorvastatin effects and baseline hs-CRP and PIIINP (P < 0.01).

CONCLUSIONS: Long-term statin therapy reduced PIIINP in this small, selected HF population with elevated baseline levels. Further evaluation of statin therapy in the management of HF patients with elevated PIIINP is warranted.

The VLT-FLAMES Tarantula Survey XXI. Stellar spin rates of O-type spectroscopic binaries

Context: The initial distribution of spin rates of massive stars is a fingerprint of their elusive formation process. It also sets a key initial condition for stellar evolution and is thus an important ingredient in stellar population synthesis. So far, most studies have focused on single stars. Most O stars are, however, found in multiple systems. 

Aims: By establishing the spin-rate distribution of a sizeable sample of O-type spectroscopic binaries and by comparing the distributions of binary subpopulations with one another and with that of presumed-single stars in the same region, we aim to constrain the initial spin distribution of O stars in binaries, and to identify signatures of the physical mechanisms that affect the evolution of the spin rates of massive stars. 

Methods: We use ground-based optical spectroscopy obtained in the framework of the VLT-FLAMES Tarantula Survey (VFTS) to establish the projected equatorial rotational velocities (ν_esini) for components of 114 spectroscopic binaries in 30 Doradus. The ν_esini values are derived from the full width at half maximum (FWHM) of a set of spectral lines, using a FWHM vs. ν_esini calibration that we derive based on previous line analysis methods applied to single O-type stars in the VFTS sample. 

Results: The overall ν_esini distribution of the primary stars resembles that of single O-type stars in the VFTS, featuring a low-velocity peak (at ν_esini<200 kms^-1) and a shoulder at intermediate velocities (200 <ν_esini<300 kms^-1). The distributions of binaries and single stars, however, differ in two ways. First, the main peak at ν_esini ~ 100kms^-1 is broader and slightly shifted towards higher spin rates in the binary distribution than that of the presumed-single stars. This shift is mostly due to short-period binaries (P_orb~<10 d). Second, the ν_esini distribution of primaries lacks a significant population of stars spinning faster than 300 kms^-1, while such a population is clearly present in the single-star sample. The ν_esini distribution of binaries with amplitudes of radial velocity variation in the range of 20 to 200 kms^-1 (mostly binaries with P_orb ~ 10-1000 d and/or with q<0.5) is similar to that of single O stars below ν_esini_~<170kms^-1. 

Conclusions: Our results are compatible with the assumption that binary components formed with the same spin distribution as single stars, and that this distribution contains few or no fast-spinning stars. The higher average spin rate of stars in short-period binaries may either be explained by spin-up through tides in such tight binary systems, or by spin-down of a fraction of the presumed-single stars and long-period binaries through magnetic braking (or by a combination of both mechanisms). Most primaries and secondaries of SB2 systems with P_orb~<10 d appear to have similar rotational velocities. This is in agreement with tidal locking in close binaries where the components have similar radii. The lack of very rapidly spinning stars among binary systems supports the idea that most stars with ν_esini_~> 300kms^-1 in the single-star sample are actually spun-up post-binary interaction products. Finally, the overall similarities (low-velocity peak and intermediate-velocity shoulder) of the spin distribution of binary and single stars argue for a massive star formation process in which the initial spin is set independently of whether stars are formed as single stars or as components of a binary system.

The VLT-FLAMES Tarantula Survey: XIX. B-type supergiants: Atmospheric parameters and nitrogen abundances to investigate the role of binarity and the width of the main sequence

Context: Model atmosphere analyses have been previously undertaken for both Galactic and extragalactic B-type supergiants. By contrast, little attention has been given to a comparison of the properties of single supergiants and those that are members of multiple systems. 

Aims: Atmospheric parameters and nitrogen abundances have been estimated for all the B-type supergiants identified in the VLT-FLAMES Tarantula survey. These include both single targets and binary candidates. The results have been analysed to investigate the role of binarity in the evolutionary history of supergiants. 

Methods: tlusty non-local thermodynamic equilibrium (LTE) model atmosphere calculations have been used to determine atmospheric parameters and nitrogen abundances for 34 single and 18 binary supergiants. Effective temperatures were deduced using the silicon balance technique, complemented by the helium ionisation in the hotter spectra. Surface gravities were estimated using Balmer line profiles and microturbulent velocities deduced using the silicon spectrum. Nitrogen abundances or upper limits were estimated from the Nii spectrum. The effects of a flux contribution from an unseen secondary were considered for the binary sample. Results. We present the first systematic study of the incidence of binarity for a sample of B-type supergiants across the theoretical terminal age main sequence (TAMS). To account for the distribution of effective temperatures of the B-type supergiants it may be necessary to extend the TAMS to lower temperatures. This is also consistent with the derived distribution of mass discrepancies, projected rotational velocities and nitrogen abundances, provided that stars cooler than this temperature are post-red supergiant objects. For all the supergiants in the Tarantula and in a previous FLAMES survey, the majority have small projected rotational velocities. The distribution peaks at about 50 km s^-1 with 65% in the range 30 km s^-1 ≤ ν_e sin i ≤ 60 km s^-1. About ten per cent have larger ve sin i (≥100 km s^-1), but surprisingly these show little or no nitrogen enhancement. All the cooler supergiants have low projected rotational velocities of ≤70 km s^-1 and high nitrogen abundance estimates, implying that either bi-stability braking or evolution on a blue loop may be important. Additionally, there is a lack of cooler binaries, possibly reflecting the small sample sizes. Single-star evolutionary models, which include rotation, can account for all of the nitrogen enhancement in both the single and binary samples. The detailed distribution of nitrogen abundances in the single and binary samples may be different, possibly reflecting differences in their evolutionary history. 

Conclusions: The first comparative study of single and binary B-type supergiants has revealed that the main sequence may be significantly wider than previously assumed, extending to T_eff = 20 000 K. Some marginal differences in single and binary atmospheric parameters and abundances have been identified, possibly implying non-standard evolution for some of the sample. This sample as a whole has implications for several aspects of our understanding of the evolutionary status of blue supergiants.

The VLT-FLAMES tarantula survey:XII. Rotational velocities of the single O-type stars

Context. The 30 Doradus (30 Dor) region of the Large Magellanic Cloud, also known as the Tarantula nebula, is the nearest starburst region. It contains the richest population of massive stars in the Local Group, and it is thus the best possible laboratory to investigate open questions on the formation and evolution of massive stars. Aims. Using ground-based multi-object optical spectroscopy obtained in the framework of the VLT-FLAMES Tarantula Survey (VFTS), we aim to establish the (projected) rotational velocity distribution for a sample of 216 presumably single O-type stars in 30 Dor. The sample is large enough to obtain statistically significant information and to search for variations among subpopulations - in terms of spectral type, luminosity class, and spatial location - in the field of view. Methods. We measured projected rotational velocities, 3e sin i, by means of a Fourier transform method and a profile fitting method applied to a set of isolated spectral lines. We also used an iterative deconvolution procedure to infer the probability density, P(3e), of the equatorial rotational velocity, 3e. Results. The distribution of 3e sin i shows a two-component structure: a peak around 80 km s1 and a high-velocity tail extending up to 600 km s^-1 This structure is also present in the inferred distribution P(3e) with around 80% of the sample having 0 <3e ≤ 300 km s^-1 and the other 20% distributed in the high-velocity region. The presence of the low-velocity peak is consistent with what has been found in other studies for late O- and early B-type stars. Conclusions. Most of the stars in our sample rotate with a rate less than 20% of their break-up velocity. For the bulk of the sample, mass loss in a stellar wind and/or envelope expansion is not efficient enough to significantly spin down these stars within the first few Myr of evolution. If massive-star formation results in stars rotating at birth with a large portion of their break-up velocities, an alternative braking mechanism, possibly magnetic fields, is thus required to explain the present-day rotational properties of the O-type stars in 30 Dor. The presence of a sizeable population of fast rotators is compatible with recent population synthesis computations that investigate the influence of binary evolution on the rotation rate of massive stars. Even though we have excluded stars that show significant radial velocity variations, our sample may have remained contaminated by post-interaction binary products. That the highvelocity tail may be populated primarily (and perhaps exclusively) by post-binary interaction products has important implications for the evolutionary origin of systems that produce gamma-ray bursts. © 2013 Author(s).

The VLT-FLAMES tarantula survey:X. Evidence for a bimodal distribution of rotational velocities for the single early B-type stars

Aims. Projected rotational velocities (ve sin i) have been estimated for 334 targets in the VLT-FLAMES Tarantula Survey that do not manifest significant radial velocity variations and are not supergiants. They have spectral types from approximately O9.5 to B3. The estimates have been analysed to infer the underlying rotational velocity distribution, which is critical for understanding the evolution of massive stars. Methods. Projected rotational velocities were deduced from the Fourier transforms of spectral lines, with upper limits also being obtained from profile fitting. For the narrower lined stars, metal and non-diffuse helium lines were adopted, and for the broader lined stars, both non-diffuse and diffuse helium lines; the estimates obtained using the different sets of lines are in good agreement. The uncertainty in the mean estimates is typically 4% for most targets. The iterative deconvolution procedure of Lucy has been used to deduce the probability density distribution of the rotational velocities. Results. Projected rotational velocities range up to approximately 450 kms-1 and show a bi-modal structure. This is also present in the inferred rotational velocity distribution with 25% of the sample having 0 <ve <100 km s^-1 and the high velocity component having v_e ∼ 250 km s^-1. There is no evidence from the spatial and radial velocity distributions of the two components that they represent either field and cluster populations or different episodes of star formation. Be-type stars have also been identified. Conclusions. The bi-modal rotational velocity distribution in our sample resembles that found for late-B and early-A type stars.While magnetic braking appears to be a possible mechanism for producing the low-velocity component, we can not rule out alternative explanations. © ESO 2013.

Searching for swept-up hydrogen and helium in the late-time spectra of 11 nearby Type Ia supernovae

The direct detection of a stellar system that explodes as a Type Ia supernova (SN Ia) has not yet been successful. Various indirect methods have been used to investigate SN Ia progenitor systems but none have produced conclusive results. A prediction of single-degenerate models is that H- (or He-) rich material from the envelope of the companion star should be swept up by the SN ejecta in the explosion. Seven SNe Ia have been analysed to date looking for signs of H-rich material in their late-time spectra and none were detected. We present results from new late-time spectra of 11 SNe Ia obtained at the Very Large Telescope using XShooter and FORS2. We present the tentative detection of Hα emission for SN 2013ct, corresponding to ∼0.007 M_⊙ of stripped/ablated companion star material (under the assumptions of the spectral modelling). This mass is significantly lower than expected for single-degenerate scenarios, suggesting that >0.1 M_⊙ of H-rich is present but not observed. We do not detect Hα emission in the other 10 SNe Ia. This brings the total sample of normal SNe Ia with non-detections (<0.001–0.058 M_⊙) of H-rich material to 17 events. The simplest explanation for these non-detections is that these objects did not result from the explosion of a CO white dwarf accreting matter from a H-rich companion star via Roche lobe overflow or symbiotic channels. However, further spectral modelling is needed to confirm this. We also find no evidence of He-emission features, but models with He-rich companion stars are not available to place mass limits.

Development and Evaluation of a Computer-Based, Self-Management Tool for People Recently Diagnosed with Type 2 Diabetes

Aim. The purpose of this study was to develop and evaluate a computer-based, dietary, and physical activity self-management program for people recently diagnosed with type 2 diabetes. 
Methods. The computer-based program was developed in conjunction with the target group and evaluated in a 12-week randomised controlled trial (RCT). Participants were randomised to the intervention (computer-program) or control group (usual care). Primary outcomes were diabetes knowledge and goal setting (ADKnowl questionnaire, Diabetes Obstacles Questionnaire (DOQ)) measured at baseline and week 12. User feedback on the program was obtained via a questionnaire and focus groups. Results. Seventy participants completed the 12-week RCT (32 intervention, 38 control, mean age 59 (SD) years). After completion there was a significant between-group difference in the “knowledge and beliefs scale” of the DOQ. Two-thirds of the intervention group rated the program as either good or very good, 92% would recommend the program to others, and 96% agreed that the information within the program was clear and easy to understand. 
Conclusions. The computer-program resulted in a small but statistically significant improvement in diet-related knowledge and user satisfaction was high. With some further development, this computer-based educational tool may be a useful adjunct to diabetes self-management.

Functional expression of a novel Kunitz type protease inhibitor from the human blood fluke Schistosoma mansoni

BACKGROUND: Schistosomes are able to survive for prolonged periods in the blood system, despite continuous contact with coagulatory factors and mediators of the host immune system. Protease inhibitors likely play a critical role in host immune modulation thereby promoting parasite survival in this extremely hostile environment. Even though Kunitz type serine protease inhibitors have been shown to play important physiological functions in a range of organisms these proteins are less well characterised in parasitic helminths.

METHODS: We have cloned one gene sequence from S. mansoni, Smp_147730 (SmKI-1) which is coded for single domain Kunitz type protease inhibitor, E. coli-expressed and purified. Immunolocalisation and western blotting was carried out using affinity purified polyclonal anti-SmKI-1 murine antibodies to determine SmKI-1 expression in the parasite. Protease inhibitor assays and coagulation assays were performed to evaluate the functional roles of SmKI-1.

RESULTS: SmKI-1 is localised in the tegument of adult worms and the sub-shell region of eggs. Furthermore, this Kunitz protein is secreted into the host in the ES products of the adult worm. Recombinant SmKI-1 inhibited mammalian trypsin, chymotrypsin, neutrophil elastase, FXa and plasma kallikrein with IC50 values of 35 nM, 61 nM, 56 nM, 142 nM and 112 nM, respectively. However, no inhibition was detected for pancreatic elastase or cathepsin G. SmKI-1 (4 μM) delayed blood clot formation, reflected in an approximately three fold increase in activated partial thromboplastin time and prothrombin time.

CONCLUSIONS: We have functionally characterised the first Kunitz type protease inhibitor (SmKI-1) from S. mansoni and show that it has anti-inflammatory and anti-coagulant properties. SmKI-1 is one of a number of putative Kunitz proteins in schistosomes that have presumably evolved as an adaptation to protect these parasites from the defence mechanisms of their mammalian hosts. As such they may represent novel vaccine candidates and/or drug targets for schistosomiasis control.

The relationship between adipokines and the onset of type 2 diabetes in middle-aged men: The PRIME study

Aims: Epidemiological evidence suggests that adipokines may be associated with the onset of type 2 diabetes, but the evidence to date is limited and inconclusive. This study examined the association between adiponectin and leptin and the subsequent diagnosis of type 2 diabetes in a UK population based cohort of non-diabetic middle-aged men.
Methods: Baseline serum levels of leptin and adiponectin were measured in 1839 nondiabetic men aged 50–60 years who were participating in the prospective populationbased PRIME study. Over a mean follow-up of 14.7 years, new cases of type 2 diabetes were determined from self-reported clinical information with subsequent validation by general practitioners.
Results: 151 Participants developed type 2 diabetes during follow-up. In Cox regression models adjusted for age, men in the top third of the leptin distribution were at increased risk (hazard ratio (HR) 4.27, 95% CI 2.67–6.83) and men in the top third of the adiponectin
distribution at reduced risk (HR 0.24, 95% CI 0.14–0.42) relative to men in the bottom third. However, significance was lost for leptin after additional adjustment for BMI, waist to hip ratio, lifestyle factors and biological risk factors, including C-reactive protein (CRP). Further adjustment for HOMA-IR also resulted in loss of significance for adiponectin.
Conclusions: This study provides evidence that adipokines are associated with men’s future type 2 diabetes risk but not independently of other risk factors.

Fruit and vegetable intake and risk of incident of type 2 diabetes: results from the consortium on health and ageing network of cohorts in Europe and the United States (CHANCES)

BACKGROUND/OBJECTIVES: There is limited information to support definitive recommendations concerning the role of diet in the development of type 2 Diabetes mellitus (T2DM). The results of the latest meta-analyses suggest that an increased consumption of green leafy vegetables may reduce the incidence of diabetes, with either no association or weak associations demonstrated for total fruit and vegetable intake. Few studies have, however, focused on older subjects.

SUBJECTS/METHODS: The relationship between T2DM and fruit and vegetable intake was investigated using data from the NIH-AARP study and the EPIC Elderly study. All participants below the age of 50 and/or with a history of cancer, diabetes or coronary heart disease were excluded from the analysis. Multivariate logistic regression analysis was used to calculate the odds ratio of T2DM comparing the highest with the lowest estimated portions of fruit, vegetable, green leafy vegetables and cabbage intake.

RESULTS: Comparing people with the highest and lowest estimated portions of fruit, vegetable or green leafy vegetable intake indicated no association with the risk of T2DM. However, although the pooled OR across all studies showed no effect overall, there was significant heterogeneity across cohorts and independent results from the NIH-AARP study showed that fruit and green leafy vegetable intake was associated with a reduced risk of T2DM OR 0.95 (95% CI 0.91,0.99) and OR 0.87 (95% CI 0.87,0.90) respectively.

CONCLUSIONS: Fruit and vegetable intake was not shown to be related to incident T2DM in older subjects. Summary analysis also found no associations between green leafy vegetable and cabbage intake and the onset of T2DM. Future dietary pattern studies may shed light on the origin of the heterogeneity across populations.European Journal of Clinical Nutrition advance online publication, 17 August 2016; 

HDL-C and HDL-C/ApoA-I predict long-term progression of glycemia in established type 2 diabetes

OBJECTIVE: Low HDL cholesterol (HDL-C) and small HDL particle size may directly promote hyperglycemia. We evaluated associations of HDL-C, apolipoprotein A-I (apoA-I), and HDL-C/apoA-I with insulin secretion, insulin resistance, HbA1c, and long-term glycemic deterioration, reflected by initiation of pharmacologic glucose control.

RESEARCH DESIGN AND METHODS: The 5-year Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study followed 9,795 type 2 diabetic subjects. We calculated baseline associations of fasting HDL-C, apoA-I, and HDL-C/apoA-I with HbA1c and, in those not taking exogenous insulin (n = 8,271), with estimated β-cell function (homeostasis model assessment of β-cell function [HOMA-B]) and insulin resistance (HOMA-IR). Among the 2,608 subjects prescribed lifestyle only, Cox proportional hazards analysis evaluated associations of HDL-C, apoA-I, and HDL-C/apoA-I with subsequent initiation of oral hypoglycemic agents (OHAs) or insulin.

RESULTS: Adjusted for age and sex, baseline HDL-C, apoA-I, and HDL-C/apoA-I were inversely associated with HOMA-IR (r = -0.233, -0.134, and -0.230; all P < 0.001; n = 8,271) but not related to HbA1c (all P > 0.05; n = 9,795). ApoA-I was also inversely associated with HOMA-B (r = -0.063; P = 0.002; n = 8,271) adjusted for age, sex, and HOMA-IR. Prospectively, lower baseline HDL-C and HDL-C/apoA-I levels predicted greater uptake (per 1-SD lower: hazard ratio [HR] 1.13 [CI 1.07-1.19], P < 0.001; and HR 1.16 [CI 1.10-1.23], P < 0.001, respectively) and earlier uptake (median 12.9 and 24.0 months, respectively, for quartile 1 vs. quartile 4; both P < 0.01) of OHAs and insulin, with no difference in HbA1c thresholds for initiation (P = 0.87 and P = 0.81). Controlling for HOMA-IR and triglycerides lessened both associations, but HDL-C/apoA-I remained significant.

CONCLUSIONS: HDL-C, apoA-I, and HDL-C/apoA-I were associated with concurrent insulin resistance but not HbA1c. However, lower HDL-C and HDL-C/apoA-I predicted greater and earlier need for pharmacologic glucose control.