Association of high-density lipoprotein cholesterol and wound healing in patients with diabetic foot ulcers

To the Editor:Diabetic foot ulcers(DFUs)are an important cause of morbidity in patients with diabetes mellitus(DM).The prevalence of foot ulcers in patients with diabetes is 4%to 10%,with the lifetime incidence estimated to be between 19%and 34%.[1]DFUs have become a considerable burden on patients and the healthcare service system.However,the mechanism is not fully understood,and DFUs are still difficult to heal.High-density lipoproteins(HDL)are circulating particles composed of phospholipids,cholesterol,and proteins.HDL attracted lots of attention mainly because of its protective effect against the development of atherosclerosis.However,it has been shown that decreased HDL levels are correlated with an increased risk of DM and its complications.The association of HDL with DFUs has also received much attention.Lower levels of HDL cholesterol were associated with increased risk for foot ulceration in patients with diabetes(odds ratio 0.427,95%confidence interval[CI]0.228-0.799,P=0.008).[2]HDL cholesterol levels were also revealed to be an independent risk factor of lower-extremity amputation and wound-related death in patients with DFUs(hazard ratio[HR]0.30,95%CI 0.14-0.63,P=0.002).Therefore,there might be a potential correlation between HDL and wound healing.