Association of High-Density Lipoprotein Cholesterol and Wound Healing in Patients with Diabetic Foot Ulcers

Diabetic foot ulcers (DFUs) affect 4–10% of people with diabetes at any given time, and up to one-third will develop them in their lifetime. These slow-healing wounds are a major cause of pain, disability, and even amputation—but scientists are still uncovering why some ulcers heal faster than others. A 2022 study suggests “good cholesterol” may hold a key clue.

High-density lipoprotein (HDL) cholesterol—often called “good cholesterol” because it helps remove harmful fat from arteries—may play a bigger role in diabetes care than we thought. Researchers at West China Hospital, Sichuan University, set out to test whether low HDL levels are linked to slower DFU healing, a question with major implications for patients and doctors.

What the Study Found

Led by Lihong Chen and Xingwu Ran from the Department of Endocrinology and Metabolism, the team analyzed data from 167 adults with DFUs (Wagner grade 2–4, meaning moderate to severe ulcers). All patients received standard care: metabolic control (managing blood sugar, blood pressure, and cholesterol), wound care (offloading, debridement, negative pressure therapy), and surgery if needed. The researchers followed them for 12 weeks to track healing.

Key results:

More than half (53%) of patients had low HDL cholesterol (below healthy levels).
Overall, 63.4% of ulcers healed within 12 weeks.
Low HDL = slower healing: Patients with HDL below 1.03 mmol/L were less likely to heal than those with higher HDL (log-rank P=0.016).
Every bit of HDL counts: When HDL was measured as a continuous value (not just “high” or “low”), each 0.13 mmol/L increase in HDL was linked to a 10% higher chance of healing (P=0.019). The top 25% of patients (HDL ≥1.30 mmol/L) were nearly twice as likely to heal as those with the lowest HDL (P=0.040).

Why HDL Matters for Wounds

In diabetes, high blood sugar and insulin resistance damage HDL particles: they become less stable, break down faster, and lose their protective effects. Healthy HDL may speed healing by:

Reducing inflammation: Chronic inflammation stalls wound repair.
Boosting blood vessel growth: HDL helps endothelial progenitor cells (EPCs)—cells that build new blood vessels—work better, which brings oxygen and nutrients to ulcers.
Speeding skin regrowth: HDL may help skin cells (keratinocytes) recover faster.

Previous research supports this: A 2009 study in The Lancet found that treating high cholesterol with fenofibrate lowered amputation risk in type 2 diabetes patients.

Limitations to Consider

The study has gaps:

Small sample: Only 167 patients were included.
HDL components: It measured only HDL cholesterol—not other parts of HDL (like apolipoproteins or paraoxonase) that may drive healing.
Single center: Results come from a tertiary care hospital, so they may not apply to all people with diabetes.

What This Means for You

If you have diabetes and a foot ulcer, ask your doctor about your HDL levels. While more research is needed to confirm if raising HDL (through diet, exercise, or medication) speeds healing, this study adds to growing evidence that “good cholesterol” is more than just a heart health marker—it’s a potential player in wound care.

The study was published in the Chinese Medical Journal in 2022. Original authors: Lihong Chen, Wanxia Ma, Dawei Chen, Chun Wang, Yun Gao, Xingwu Ran. Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University. doi.org/10.1097/CM9.0000000000001544

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