IJCRR - 4(7), April, 2012
Pages: 11-15
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DIABETIC CARDIOVASCULAR COMPLICATIONS AND DYSLIPIDEMIA: A HOSPITAL BASED CROSS SECTIONAL STUDY IN NORTHWEST INDIA
Author: Sharma Ashish, Agrawal Apurva, Sharma Anita
Category: Healthcare
Abstract:Aim: To investigate the strength of association of each parameter of deranged lipid profile with diabetic cardiovascular complications Methods: This was a hospital based cross sectional study which included 150 diabetic patients who visited shree krishna hospital from May 2008 to April 2009. Lipid profile of all the patients was estimated by fully autoanalyser, cardiovascular complications assessed by Echo-cardio graphic changes and Electro cardiogram (ECG) changes. Results: The prevalence of dyslipidemia is higher in diabetic population in our study. Serum cholesterol >240 mg/dl was seen in 14%, serum triglycerides >160 mg/dl was seen in 43.33 %, raised LDL (low density lipoproteins) >130 mg/dl in 35.33 %, VLDL (very low density lipoproteins) >40 mg/dl in 25.33% and low levels of HDL (high density lipoproteins)< 40 mg/dl were seen in 46.66 %. Though duration of disease, use of statins, abnormal level of cholesterol and lipoproteins also influence the development of diabetic cardiovascular complications,but on multiple logistic regression analysis, CVD (cardiovascular disease) had strong correlation with high levels of LDL only. Conclusion: Our study showed that Lipid profile abnormalities which are very common in type 2 diabetes, have a great influence on CVD. Estimated cardiovascular risk can be correlated with abnormal lipid profile, especially high level of LDL.
Keywords: Dyslipidemia, Type II Diabetes, Cardiovascular complications
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INTRODUCTION
Diabetes Mellitus and its associated complications have become a public health problem of considerable magnitude. Cardiovascular disease (CVD) is the most prevalent complication and is associated with excess morbidity and mortality in diabetic patients. (1)The etiopathogenesis of the longterm complications of diabetes is not fully understood and controversies exist about why they occur in some patients and not in others. (2) Though role of dyslipidemia in the development of diabetic complications is well known but data regarding individual parameter of deranged lipid profile are lacking. Various risk factors act synergistically for the development of cardiovascular complications in type II diabetes and the contribution of individual risk factor is yet to be clearly identified and quantified. (3) Thus the present study aimed to assess the effect of dyslipidemia on cardiovascular complications in western India.
MATERIAL AND METHODS
Study population
In this hospital based cross-sectional prospective study, total 150 type II diabetic patients attending diabetic clinic and medicine OPD at shree krishna hospital, PSMC, karamsad during May 2008 to April 2009 were included. Patients were confirmed for diabetes by clinical and biochemical diagnosis based on American Diabetes Association revised criteria. (4) Approval from the institutional ethics committee was taken prior to study. The patients included in the study were informed about the study in brief, in their local language, and then written consent was taken from them. Study design Diabetic patients were evaluated for presence of cardiovascular complications which was assessed by either Electrocardiogram or Echocardiographic changes. Lipid profile was done by fully-auto analyzer (ERBA -XL-300). Triglyceride level was estimated by GPO (trinder) method. (5) Total cholesterol was estimated by CHOD-POD method (6), while HDL estimation was done by phosphotungustic method. (7) Blood glucose was estimated by glucose oxidase method (8) and glycosylated hemoglobin by immunoturbidometric method. (9) Estimated values of total cholesterol >240 mg/dl, serum triglycerides >160 mg/dl, HDL 130 mg/dl and VLDL >40 mg/dl were considered as abnormal. Statistical analysis Means or proportions for baseline clinical and laboratory characteristics were computed for subjects with and without cardiovascular risk. Ttest was used to compare means and chi square test was used to compare proportions. Significance tests were two tailed and p-values less than 0.05 were considered statistically significant. Multiple Logistic regression analysis was used to assess effect of individual variable in the development of cardiovascular complication of diabetes. RESULTS The details of demographic profile of the study population revealed that the mean age of the study population was 60.4 years, with average duration of diabetes 9.7 years. Mean fasting blood sugar was 161.9 ± 51.7 mg/dl and mean glycosylated hemoglobin was found to be 8.2 %. Mean serum cholesterol was 182.9 ± 50 mg/dl, serum HDL was 40.6 ± 13.2 mg/dl, serum LDL was 110.3 ± 41.3 mg/dl, serum VLDL was 35.8 ± 23.8 mg/dl and serum triglyceride (TG) was 175.8 ± 110 mg/dl. Data regarding lipid profile showed that out of 150 patients, hypertriglyceridemia is most common abnormality in diabetic patients, followed by high level of LDL and VLDL. Serum TG levels were high (>160 mg/dl) in 43.33 % patients, while high LDL level (>130 mg/dl) were found in 35.33% patients. Comparison of means revealed that duration of disease, serum cholesterol, serum LDL, serum VLDL and serum triglyceride levels were significantly associated with the cardiovascular complication, with p value < 0.05. While age of patients, serum HDL levels, fasting blood sugar levels (FBS) and PP2BS levels did not have statistically significant association with cardiovascular complication. (Table-1) Use of statins in diabetic patients was found to be significantly associated with reduction of cardiovascular complications. Sex of the patients, glycosylated hemoglobin levels and smoking were not found to be significantly associated with the risk of cardiovascular complications, with p values more than 0.05. (Table-2) On application of multiple logistic regression and after adjusting all the variables mutually, only serum LDL level was found to be significantly associated with the development of cardiovascular complication in diabetes patients with approximately a threefold increase in the risk of cardiovascular complications (OR 2.7, 95% CI 1.5613 to 4.8532). (Table-3) DISCUSSION The present study showed the prevalence of dyslipidemia in diabetic population of west India comprising rural population. Dyslipidemia is an established risk factor for CAD in patients with type II diabetes, (10, 11) which include low HDL levels, raised triglycerides and raised LDL levels. LDL is a major determinant of atherosclerosis in patients with diabetes, results are consistent with study of R.P. Agrawal et al, in which changes in LDL particle composition such as density, oxidation potential and glycation, render even normal LDL levels as highly atherogenic. (3) The Strong Heart Study, which was an American Indian population based study, concluded that each 10 mg/dl increase in LDLcholesterol corresponded to a 12% increase in cardiovascular risk. (12). Similar information was also observed in present study, in which LDL-cholesterol was the most important independent variable in the model used for multivariate analysis, while from baseline data of the United Kingdom Prospective Diabetes Study (UKPDS), Stratton IM et al revealed that both decreased HDL and elevated LDL predict CHD. (13) There were some limitations in the present study, sample size was small and it was a hospital based study, so can‘t represent whole population. There is a need to perform such studies on larger and community based population. CONCLUSION In conclusion, the results of our study showed that in type 2 diabetes population of western India, estimated cardiovascular risk correlated with abnormal lipid profile, especially high serum levels of LDL. These data could explain the failure of intensive glycemic control in reducing cardiovascular events observed in diabetic patients. Duration of disease also had strong impact on diabetic complications. Patients on hypolipidemic drugs had an inverse relationship with the development and progression of cardiovascular complications, while patient‘s age, sex, and smoking behavior did not show statistically significant asssociation. More studies are required for development of appropriate preventive and treatment strategies to reduce diabetic cardiovascular complications. ACKNOWLEDGEMENT We acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. We are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
References:
1. Schalkwijik CG, Stehouwer CDA. Vascular complications in diabetes mellitus: the role of endothelial dysfunction. Clin Sci 2005;109:143-59.
2. Zimmet P, Alberti KGMM, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001 Dec 13;414:782-7.
3. Agrawal RP, Sharma P, Pal M, Kochar A, Koachar DK. Magnitude of dyslipedemia and its association with micro and macro vascular complications in type 2 diabetes: a hospital based study from Bikaner (Northwest India). Diabetes Res Clin Pract 2006;73:211-4.
4. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2004; 27:s5-s10.
5. McGowan MW, Artiss JD, Strandbergh DR, Zak B. A peroxidase-coupled method for the colorimetric determination of serum triglycerides. Clin Chem 1983; 29:538-42
6. Richmond W. Preparation and properties of cholesterol oxides from nocardia sp. and its application to the enzymatic assay of total cholesterol in serum. Clin Chem 1973;19:1350-6.
7. Rifal N, Warnick GR editors. Laboratory measurement of lipids, lipoproteins and apolipoproteins. Washington DC: American Association of Clinical Chemistry (AACC) press; 1994 p. 21 – 42.
8. Trinder P. Determination of Glucose in blood using glucose oxidase with an alternate oxygen acceptor. Ann Clin Biochem 1969;6:24–7.
9. Trivelli LA, Ranney HM, Lai HT. Hemoglobin components in patients with diabetes mellitus. N Engl J Med 1971;284:353-7.
10. Adult Treatment Panel. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143-421.
11. Berthezène F. Diabetic dyslipidaemia. Br J Diabetes Vasc Dis. 2002;2(1):S12–7.
12. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention trail. Diabetes Care 1993;16:434–44.
13. Stratton IM, Adler AI, Neil HAW, Matthews DR, Manley SE, Cull CA et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405–12.
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