2型糖尿病合并高血压患者血清脂联素水平与胰岛素抵抗的关系

目的：观察2型糖尿病患者加之高血压、肥胖因素血清脂联素水平与单纯2型糖尿病患者及正常人群的差异，分析血清脂联素水平与胰岛素抵抗的关系。方法：选择2004-11／2005-12桂林医学院附属医院内分泌科、糖尿病防治中心住院及门诊2型糖尿病患者240例，以是否合并有高血压为标准分为两组，即高血压组120例，肥胖者（体质量指数≥25kg／m^2）68例，非肥胖者（体质量指数〈25kg／m^2）52例；非高血压组120例，肥胖者62例，非肥胖者58例；另纳入健康者50例为对照组。分别检测以上3组患者的空腹脂联素、瘦素、肿瘤坏死因子、胰岛素、空腹和馒头餐后2h血糖、糖化血红蛋白、体质量指数、血压、总胆固醇、三酰甘油，计算胰岛素敏感指数，比较脂联素水平变化，并与其他因素进行相关分析及逐步回归分析，观察其与胰岛素抵抗的关系。结果：参与观察的2型糖尿病患者240例及健康者50例全部进入结果分析。①2型糖尿病合并高血压组空腹血糖、胰岛素、C肽及餐后2h血糖与其他两组比较，差异有非常显著性意义（P〈0．01）；体质量指数、瘦素、肿瘤坏死因子、收缩压、舒张压、总胆固醇、三酰甘油、糖化血红蛋白、胰岛素敏感指数与其他两组比较，差异有显著性意义（P〈0．05）。②2型糖尿病合并高血压组和单纯2型糖尿病组血清脂联素水平低于正常对照组（P〈0．01）；2型糖尿病合并高血压组血清脂联素水平低于单纯2型糖尿病组（P〈0．01）；肥胖者均低于非肥胖者（P〈0．05～0．01）。③多元线性相关分析显示，2型糖尿病合并高血压组中，脂联素与体质量指数、收缩压、空愎血糖、胰岛素、三酰甘油、瘦素、肿瘤坏死因子α之间存在显著负相关，与胰岛素敏感指数呈独立正相关，进入回归方程的因素为脂联素、瘦素、肿瘤坏死因子α、体质量指数，三酰甘油、收缩压；2型糖尿病非高血压组中，脂联素与空愎血糖、胰岛素、三酰甘油，瘦素、肿瘤坏死因子α之间存在显著负相关，与胰岛素敏感指数呈独立正相关，进入回归方程的因素为脂联素、瘦素、肿瘤坏死因子α，三酰甘油。结论：在2型糖尿病患者中，血清脂联素水平明显降低，合并高血压者血清脂联素水平更低，与胰岛素敏感指数呈独立正相关，脂联素水平与高血压之间存在一定的相关性。     

2型糖尿病家系神经肽Y血浆水平研究

目的：探讨2型糖尿病家系成员的外周血神经肽Y蛋白水平及其与胰岛素抵抗特征间的关系。方法：收集120例无血缘关系的2型糖尿病家系成员（包括2型糖尿病患者和非糖尿病一级亲属），应用放射免疫法检测外周血神经肽Y蛋白表达水平，同时检测血糖、血脂、胰岛素代谢水平，计算个体的胰岛索敏感性（ISI）和胰岛素抵抗指数（HOMA-IR），并与正常对照49例相比较。结果：2型糖尿病家系成员的空腹血浆NPY水平明显高于正常对照组。糖尿病组的年龄、体质指数、收缩压、空腹血糖、C肽和HOMA-IR等明显高于其他两组，而高密度脂蛋白胆固醇、ISI明显低于其他两组。一级亲属组的收缩压、低密度脂蛋白胆固醇、C肽、空腹胰岛索明显高于正常对照组。2型糖尿病患者病程越长、血糖水平越高、合并高血压则空腹血浆NPY水平明显增高。多元相关与回归分析显示糖尿病病程是影响糖尿病患者空腹血浆NPY水平的主要因素。结论：2型糖尿病家系成员的外周血神经肽Y蛋白表达高于正常对照。这种高表达可能参与2型糖尿病的发生、发展。     

2型糖尿病合并冠心病患者血清脂联素水平测定及临床意义

目的探讨2型糖尿病（DM）合并冠心病（CHD）患者血清脂联素水平与体重指数（BMI）、腰臀比（WHR）、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、胰岛素抵抗指数（Homa-IR）等相关因素的关系。方法用放射免疫法检测单纯2型DM组、2型DM合并CHD组及正常对照组的脂联素和胰岛素，用日立全自动生化分析仪测定FBG、血脂，测量所有观察对象的身高、体重、腰围和臀围并测定其尿白蛋白排泄率。结果单纯2型DM组、2型DM合并CHD组血清脂联素水平均低于正常对照组（P〈0．01）；2型DM合并CHD组显著低于单纯2型DM组（P〈0．01）。2型DM2组Homa-IR均高于正常对照组。脂联素与WHR、Homa—IR呈独立负相关（P〈0．01）。结论2型DM合并CHD患者血清脂联素水平与胰岛素抵抗之间存在密切的相关性，血清脂联素在2型DM及合并CHD的发生发展中起着重要作用。     

血浆脂联素水平与2型糖尿病及其大血管病变发生的相关性

目的：观察2型糖尿病及其并发大血管病变患者中的血浆脂联素水平，探讨血浆脂联素水平与2型糖尿病及其大血管病变的关系。 方法：选择2004-02／2005-02在广西医科大学附属第五医院内分泌科住院的2型糖尿病患者103例，根据是否合并大血管病变分为2组，糖尿病并大血管病变组49例，糖尿病无大血管病变组54例；同时选择在本院进行健康体检者35例作为对照组，均知情同意。测定以上观察对象的血浆脂联素水平应用放射免疫法，同时测定血糖、血压、血脂、C肽水平。比较各组间血浆脂联素水平、低脂联素血症发生率(以血浆脂联素水平<5mg／L判为降低)，分析其影响因素。探讨脂联素与糖尿病大血管并发症危险因素的相关性采用相关分析以及多元逐步回归分析。 结果：大血管病变组49例，无大血管病变组54例，正常对照组35例，全部进入结果分析。①各组血浆脂联素水平：糖尿病大血管病变组显著低于无大血管病变组和对照组[(4．08±3．24)mL／L，(6．69±4．42)mL／L，(16．37±3．03)mL／L，(t=3．440，17．606，P<0．01)]。无大血管病变组显著低于对照组(t=12．257，P<0．05)。②各组低脂联素血症发生率：大血管病变组、无大血管病变组均显著高于对照组[73．5％，40．0％，0(X~2=42．050，16．815，P<0．01)]，其中大血管病变组显著高于无大血管病变组(X~2=9．894，P<0．01)。③脂联素水平与糖尿病大血管并发症危险因素之间的相关性：血浆脂联素水平与收缩压呈负相关(r=-0．309，P<0．01)。 结论：2型糖尿病患者血浆脂联素水平降低，并发大血管病变者降低更加明显，且与糖尿病大血管病变的危险因素收缩压水平呈显著负相关，提示血浆脂联素与2型糖尿病及其大血管病变的发生发展密切相关。     

2型糖尿病合并大血管病变患者血浆脂联素水平观察

脂联素是新近发现的由脂肪细胞特异性分泌的蛋白质，与胰岛素抵抗、2型糖尿病（T2DM）及心血管疾病密切相关，为此，我们对T2DM及其大血管病变患者血浆脂联素水平的变化情况进行探讨，现报告如下。     

冠心病合并糖尿病患者血清内脂素和脂联素水平的变化分析

选取我院2013年10月~2014年3月经冠状动脉造影确诊为冠心病(至少有一支冠脉狭窄≥50%)的住院患者260例。将患者分为冠心病合并DM组90例和冠心病非DM组170例。另选取同期健康体检者70名作为对照组。采用ELISA测定血清内脂素、脂联素水平。同时检测TC、TG、HDL-C、LDL-C、FPG、BUN及cr水平。采用多元相关分析内脂素、脂联素与其他指标之间的相关性。结果冠心病非DM组血清内脂素水平高于对照组,脂联素水平低于对照组(P0.01)。而冠心病合并DM组血清内脂素水平明显高于冠心病非DM组,脂联素水平明显低于冠心病非DM组(P0.01)。多元相关分析显示,冠心病合并DM患者血清Visfatin与FBG、H0MA-IR、LDL-C呈明显正相关;冠心病合并DM患者血清APN与FBG、BMI、HOMA-IR呈明显负相关,与HDL-C呈明显正相关。血清内脂素和脂联素在冠心病合并糖尿病的发生发展中起重要作用。     

2型糖尿病合并高甘油三酯血症患者血浆脂联素的变化

目的了解2型糖尿病及其合并高甘油三酯血症患者中血浆脂联素水平的状况。方法对2型糖尿病有高甘油三酯血症组64例、2型糖尿病无高甘油三酯血症组39例、健康对照组35例,测定其血浆脂联素水平,同时测定糖尿病患者的身长、体重、血糖、血压、C肽水平,比较三组间血浆脂联素平均水平、低脂联素血症发生率,分析其影响因素。结果糖尿病有高甘油三酯血症组、糖尿病无高甘油三酯血症组及正常对照组血浆脂联素水平分别为(4.46±3.11)μg/ml、(7.22±4.94)μg/ml、(16.37±3.03)μg/ml,组间差异均有显著意义(P<0.05);三组中低脂联素血症发生率分别为62.5%、38.5%及0.0%,差异均有显著意义(P<0.05)。在糖尿病患者中,血浆脂联素与收缩压呈负相关(P<0.001)。结论2型糖尿病患者血浆脂联素水平明显降低,并发高甘油三酯血症者降得更低,提示血浆脂联素与2型糖尿病及高甘油三酯血症有密切关系,脂联素的增加可能对高甘油三酯水平的下降有益。     

2型糖尿病视网膜病变患者血清脂联素水平的研究

目的 为观察血清脂联素水平的变化与2型糖尿病合并视网膜病变(DR)各期的关系.方法 采用ELISA法对113例2型糖尿病患者血清脂联素水平进行检测,其中2型糖尿病无DR患者30例(DM组)、2型糖尿病合并DR背景型患者45例(BDR组)、2型糖尿病合并DR增殖型患者38例(PDR组)和健康对照30例(NC组).结果 (1)DM组血清脂联素水平与NC组比较差异有统计学意义(P＜0.05);BDR组血清脂联素水平与DM组、NC组比较差异均有统计学意义(P＜0.05或P＜0.01);PDR组血清脂联素水平与BDR组、DM组、NC组比较差异均有统计学意义(P＜0.05或P＜0.01).(2)相关分析发现,2型糖尿病患者血清脂联素水平与收缩压、糖化血红蛋白、TG、TC、LDL-C成显著负相关,而与HDL-C成显著正相关.结论 2型糖尿病患者血清脂联素水平明显降低, 2型糖尿病合并DR后血清脂联素水平更低.脂联素可作为判断2型糖尿病合并DR损害程度的指标.     

同型半胱氨酸与糖尿病患脑梗死相关分析

目的：探讨同型半胱氨酸水平与2型糖尿病患者是否合并脑梗死的关系。方法：2型糖尿病患者40例,合并脑梗死20例（DCI组）,无脑梗死20例（DNC组）,同时人组正常对照20例（CON组）。同时测定空腹血糖（FBG）、空腹胰岛素水平（FINs）、胰岛素抵抗指数（HOMA—IR）、血浆同型半胱氨酸（HCY）、胆固醇（Tc）、甘油三酯（TG）、糖化血红蛋白水平（HbAlc）。结果：糖尿病合并脑梗死组血浆HCY水平较无脑梗死组明显升高,有统计学差异（P〈0．05）;两组HCY水平均高于正常对照组,有统计学差异（P〈0．01）。结论：同型半胱氨酸水平与糖尿病、脑梗死密切关联,是脑血管疾病的危险因素。     

2型糖尿病患者肾上腺皮质功能的昼夜变化及影响因素

目的：分析2型糖尿病患者肾上腺皮质功能的变化及其相关因素，以期发现对其介入康复干预措施的可能性。方法：宁夏医学院附属医院进行体检检查确定的健康人30例(正常对照组)，经糖耐量试验及正规体检，排除糖尿病及其他系统慢性疾病的存在；3个月内无外伤、感染、发热等应激状况。男18例，女12例。就诊于宁夏医学院附属医院门诊与住院部的2型糖尿病患者91例(2型糖尿病组)，男58例，女33例。入选患者均经1999年世界卫生组织诊断标准确诊的2型糖尿病患者；病史均&;gt;1年；无明显肾功能、肝功能异常者；排除近3个月内有外伤、感染、发热等应激状况患者；排除有过敏，正在使用激素治疗患者；排除在服用除口服降糖药物和胰岛素的患者。2型糖尿病组分为两个亚组：合并慢性并发症组53例，男32例，女21例。未合并慢性并发症组38例，男26例，女12例。分别送检空腹血糖、三酰甘油、总胆固醇、糖化血红蛋白、血皮质醇和血醛固酮；餐后2h血糖；于下午16：00采取同侧肘静脉血，送检血皮质醇。结果：91例2型糖尿病患者8：00皮质醇观测值为(222．0&;#177;74．0)μg／L，16：00皮质醇观测值为(134．0&;#177;63．0)μg／L；正常对照组8：00皮质醇观测值为(105&;#177;67)μg／L，16：00皮质醇观测值为(63&;#177;31)μg／L；2型糖尿病组明显高于正常对照组(t=2．33，P&;lt;0．05)，同时发现在2型糖尿病患者中存在血皮质醇昼夜节律变化的减弱，甚至消失。合并慢性并发症组患者8：00皮质醇和16：00皮质醇测定结果均显著高于未合并慢性并发症组(t=2．02，2．16，P&;lt;0．05)。2型糖尿病患者血醛固酮平均值较正常对照组低，且醛固酮单因素相关分析中发现，其血醛固酮观测值与病程、血糖控制水平、血糖伸缩度以及尿微量白蛋白呈相关性。结论：2型糖尿病患者血皮质醇分泌增多，血醛固酮的分泌减少，从而进一步的导致糖、脂代谢的异常造成并发症发生概率的增加。     

Possible impairment of transcardiac utilization of adiponectin in patients with type 2 diabetes

OBJECTIVE: Adiponectin, an adipocyte-derived protein, has been suggested to enhance insulin sensitivity and prevent atherosclerosis. Circulating adiponecin levels are reduced in states of insulin resistance such as type 2 diabetes. We examined transcardiac utilization of adiponectin in patients with and without type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 17 male type 2 diabetic patients and 17 male nondiabetic patients were investigated. Venous blood samples were taken to measure glucose and lipid variables. Blood samples for the measurement of adiponectin were collected simultaneously from the aortic root and coronary sinus. Angiographic semiquantitative stenosis score of coronary artery was also evaluated. RESULTS: The adiponectin levels in both the aortic root and coronary sinus in the diabetic patients were significantly lower than those in the nondiabetic patients. The adiponectin level was significantly lower in the coronary sinus than in the aortic root in the nondiabetic patients, but there was no significant difference between adiponectin levels in the aortic root and coronary sinus in the diabetic patients. The total stenosis score, as an index of severity of coronary artery stenosis, was significantly higher in the diabetic patients than in the nondiabetic patients. The stenosis score was correlated with the degree of transcardiac utilization of adiponectin from the aortic root to coronary sinus in the nondiabetic patients but not in the diabetic patients. CONCLUSIONS: Diabetic patients not only have a decreased adiponectin level in the basal state compared with nondiabetic patients but also have impaired utilization of adiponectin in the coronary artery and/or the heart, which may promote the development of atherosclerosis.     

Hyperhomocysteinemia is a risk factor for coronary arteriosclerosis in Japanese patients with type 2 diabetes

OBJECTIVE: An increased plasma homocysteine level is an important risk factor for vascular disease, including coronary atherosclerosis, in the general population. However, the role of hyperhomocysteinemia in the development of coronary artery disease (CAD) in patients with type 2 diabetes is unknown. Therefore, we have endeavored to determine the relationship between plasma homocysteine levels and the presence of coronary arteriosclerosis in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: The study group consisted of 145 Japanese patients (95 men and 50 women) who underwent routine coronary angiography to assess chest pain or suspected CAD. Plasma total homocysteine level, lipid level, and parameters of fibrinolytic activity were measured. All patients were identified as diabetic or nondiabetic by the new American Diabetes Association (ADA) criteria. The diagnoses of all patients studied were confirmed by coronary angiography. The severity of coronary artery stenosis was quantified using CAD scoring on the basis of prior reports, and subjects were graded as nonstenotic, stenotic single-vessel, stenotic two-vessel, or stenotic three-vessel based on the number of stenotic coronary arteries. Patients were classified into two groups: those with stenotic vessels and those without stenotic vessels. RESULTS: The plasma homocysteine level was significantly higher in patients with than in patients without stenotic vessels (13.8 +/- 3.9 vs. 11.7 +/- 3.9 mumol/l, respectively; P = 0.0009). The number of stenotic coronary arteries, which was used to grade each case as nonstenotic, stenotic single-vessel, stenotic two-vessel, or stenotic three-vessel, was related only to the total homocysteine level in the diabetic (diabetes mellitus [DM]) group, but it was associated with lipoprotein(a) in the nondiabetic (non-diabetes mellitus [non-DM]) group. Spearman's rank correlation test demonstrated that the plasma homocysteine level was strongly correlated with CAD score, both in the entire study group and in the DM group (P = 0.003 for the entire group and P = 0.011 for the DM group). Hyperhomocysteinemia, which was defined as total homocysteine level > 14.0 mumol/l, was seen in 57 (39.3%) of the patients. The CAD score was highest in diabetic patients with hyperhomocysteinemia (P < 0.05). CONCLUSIONS: There seems to be a clear relationship between hyperhomocysteinemia and an increased risk of coronary arteriosclerosis in Japanese patients with type 2 diabetes.     

Advanced glycation end products in nondiabetic patients with coronary artery disease

OBJECTIVE: To investigate whether advanced glycation end products (AGEs) participate in the development of coronary artery disease (CAD) in nondiabetic and diabetic subjects. RESEARCH DESIGN AND METHODS: Serum concentrations of AGEs were measured using a newly established enzyme-linked immunosorbent assay in 48 nondiabetic patients (normal glucose tolerance, n = 20; impaired glucose tolerance, n = 28) who received coronary angiography for the study of chest pain or suspected CAD. Insulin sensitivity was examined by the euglycemic-hyperinsulinemic glucose clamp technique and was estimated as the mean glucose infusion rate during the last 30 min of clamp time (M value). RESULTS: Patients were classified into four groups based on the number of significantly stenosed vessels, defined as 0-, 1-, 2-, or 3-vessel disease. Serum concentrations of AGEs were significantly higher in nondiabetic subjects with CAD than in control subjects (2.42 +/- 0.65 vs. 1.96 +/- 0.40 mU/ml, P < 0.01) and significantly correlated with the number of significantly stenosed vessels (r = 0.678, P < 0.001). M values significantly inversely correlated with serum concentrations of AGEs (r = -0.490, P < 0.05). In multiple regression analysis, with the number of significantly stenosed vessels as the dependent variable, serum concentrations of AGEs, 2-h plasma glucose, and areas under the plasma glucose response curve were independently associated. CONCLUSIONS: This pilot study indicates the relation between AGEs and the severity of CAD in nondiabetic patients. The measurement of serum AGE concentrations may be predictive of vascular damage.     

Soluble L-selectin level is a marker for coronary artery disease in type 2 diabetic patients

OBJECTIVE: To investigate whether the fall in soluble L-selectin (sL-selectin) level constitutes a marker for myocardial ischemia. RESEARCH DESIGN AND METHODS: The levels of soluble forms of adhesion molecules, i.e., intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), E-selectin (sE-selectin), P-selectin (sP-selectin), and L-selectin (sL-selectin), were compared in type 2 diabetic patients without inflammatory syndrome but with symptomatic coronary artery disease (CAD) (group 1, n = 11), with silent ischemic disorders and proven coronary stenoses (group 2, n = 11), with silent myocardial ischemia (SMI) and normal coronary angiography (group 3, n = 10), and without proven SMI (group 4, n = 13). These levels were compared with those of 22 control subjects. RESULTS: The sL-selectin level was significantly lower in groups 1, 2, or 3 with symptomatic CAD or with SMI as compared with the control group (P = 0.0004). Group 4 without myocardial ischemia did not significantly differ from the control subjects (P = 0.6). In type 2 diabetic patients, after controlling for HbA1c, a partial correlation between sL-selectin and the CAD status was significant (P = 0.001). sICAM-1 and sP- or sE-selectin did not differ significantly between type 2 diabetic patients and control subjects or among the different groups of patients. The sVCAM-1 level in type 2 diabetic patients was significantly higher than in the control subjects (P = 0.001), but there were no significant intergroup differences (P = 0.4). CONCLUSIONS: In type 2 diabetic patients, sVCAM-1 is increased with regard to glycemic control, whatever the CAD status. In type 2 diabetic patients with symptomatic CAD or SMI associated with coronary stenoses, sL-selectin is significantly decreased. A marked fall in sL-selectin might constitute a marker for silent CAD in type 2 diabetic patients.     

The +276 G/T single nucleotide polymorphism of the adiponectin gene is associated with coronary artery disease in type 2 diabetic patients

OBJECTIVE: Two single nucleotide polymorphisms (SNPs) at the adiponectin locus (+45T>G and +276G>T) have been associated with low circulating adiponectin levels, insulin resistance, and type 2 diabetes. We investigated whether these genetic markers are determinants of coronary artery disease (CAD) in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: A total of 376 consecutive type 2 diabetic patients were studied: 142 case subjects with coronary stenosis >50% or previous myocardial infarction and 234 control subjects with no symptoms, no electrocardiogram (ECG) signs of myocardial ischemia, and a normal ECG stress test (n = 189) and/or (n = 45) with coronary stenosis T polymorphism is a determinant of CAD risk in type 2 diabetic patients. This marker may assist in the identification of diabetic individuals at especially high risk of CAD, so that preventive programs can be targeted at these subjects.     

Osteoprotegerin is associated with silent coronary artery disease in high-risk but asymptomatic type 2 diabetic patients

OBJECTIVE: Osteoprotegerin (OPG) is an inhibitor of osteoclastogenesis, which has been recently involved in atherosclerosis. The relationship between coronary atherosclerosis and OPG has never been studied in asymptomatic type 2 diabetic patients. RESEARCH DESIGN AND METHODS: This is a nested case-control study; 162 asymptomatic type 2 diabetic patients were evaluated for silent myocardial ischemia using stress myocardial perfusion imaging; of 50 patients with positive results, 37 underwent coronary angiography, 20 of whom showed significant coronary artery disease (CAD group). Of 112 patients without silent myocardial ischemia, 20 subjects (NO-CAD group) were selected and matched by age and sex to patients with CAD. OPG, C-reactive protein, adiponectin, lipoprotein(a), albuminuria, and classical risk factors were measured. RESULTS: The percentages of subjects with OPG levels above median and with nephropathy were higher in the CAD group than in the NO-CAD group (70 vs. 25%, P = 0.004 and 50 vs. 5%, P = 0.001, respectively). LDL cholesterol levels were higher and HDL cholesterol levels lower in the CAD compared with the NO-CAD group (P = 0.033 and P = 0.005, respectively). No other variables were associated with CAD. Logistic regression analysis showed that OPG values above median (odds ratio 8.31 [95% CI 1.18-58.68], P = 0.034) and nephropathy (21.98 [1.24-388.36], P = 0.035) were significant independent predictors of asymptomatic CAD in type 2 diabetic patients. CONCLUSIONS: Our investigation reports the first evidence of an independent association of OPG with asymptomatic CAD in type 2 diabetic patients. The results of this nested case- control study with 20 cases need to be confirmed in a larger population.     

Coffee consumption is associated with higher plasma adiponectin concentrations in women with or without type 2 diabetes: a prospective cohort study

To test whether the beneficial effects of coffee consumption in metabolism might be explained by changes in circulating levels of adiponectin, we evaluated self-reported habitual coffee and tea consumption and caffeine intake as predictors of plasma adiponectin concentrations among 982 diabetic and 1,058 nondiabetic women without cardiovascular disease from the Nurses' Health Study. Women with and without diabetes who drank >or=4 cups of coffee per day had significantly higher adiponectin concentrations than those who didn't drink coffee regularly (7.7 vs. 6.1 microg/ml, respectively, in diabetic women, P = 0.004; 15.0 vs. 13.2 microg/ml in nondiabetic women, P = 0.04). Similar associations were observed for caffeine intake. We confirm previously reported inverse associations of coffee consumption with inflammatory markers, C-reactive protein, and tumor necrosis factor-alpha receptor II. Adjustment for adiponectin did not weaken these associations, and adjustment for inflammatory markers did not attenuate the association between coffee consumption and adiponectin concentrations. High consumption of caffeine-containing coffee is associated with higher adiponectin and lower inflammatory marker concentrations.     

Coronary artery disease and carotid artery intima-media thickness in Japanese type 2 diabetic patients

OBJECTIVE: To investigate the association between carotid atherosclerosis, measured as intima-media thickness (IMT), and cardiovascular morbidity in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: We investigated the relationship between IMT and coronary artery disease (CAD) in 40 type 2 diabetic patients and 40 control subjects. Diabetic patients with CAD determined by coronary angiography were consecutively recruited, whereas the control subjects were recruited from among diabetic outpatients without CAD at the same institution. IMT was measured in both carotid arteries using B-mode ultrasonography. RESULTS: Carotid IMT was significantly greater in the diabetic patients than in the control subjects (1.27 +/- 0.07 vs. 1.03 +/- 0.04 mm, P < 0.05). IMT was associated with CAD by logistic regression analysis using all independent variables (P = 0.062). When the 40 patients with CAD were divided into a group of 20 patients with coronary artery bypass grafting (CABG) and another 20 patients without CABG, the IMT was significantly greater in the CABG group than in the non-CABG group (1.47 +/- 0.11 vs. 1.07 +/- 0.07 mm, P < 0.05). CONCLUSIONS: These results indicate that the presence of carotid atherosclerosis implies a high probability of coronary involvement in Japanese nonobese subjects with type 2 diabetes.     

Decreased plasma lipoprotein lipase in hypoadiponectinemia: an association independent of systemic inflammation and insulin resistance

OBJECTIVE: Adiponectin is a plasma protein expressed in adipose tissue. Hypoadiponectinemia is associated with low HDL cholesterol and high plasma triglycerides, which also characterize lipoprotein lipase (LPL) deficiency syndromes. Recently, dramatically increased LPL activity was reported in mice overexpressing adiponectin. We therefore speculated that adiponectin may directly affect LPL in humans. RESEARCH DESIGN AND METHODS: We measured plasma adiponectin and postheparin LPL in 206 nondiabetic men and in a second group of 110 patients with type 2 diabetes. Parameters were correlated with markers of systemic inflammation (C-reactive protein [CRP]) and insulin resistance (homeostatis model assessment of insulin resistance [HOMA-IR]). RESULTS: Nondiabetic subjects with decreased plasma adiponectin had lower LPL activity (r=0.42, P <0.0001). This association of plasma adiponectin with LPL activity was confirmed in the second group of patients with type 2 diabetes (r=0.37, P <0.0001). Multivariate analysis revealed that adiponectin was the strongest factor influencing LPL activity, accounting for 23% of the variation in LPL activity in nondiabetic subjects and for 26% of the variation in LPL activity in type 2 diabetic patients. These associations were independent of plasma CRP and HOMA-IR. CONCLUSIONS: These results demonstrate an association of decreased postheparin LPL activity with low plasma adiponectin that is independent of systemic inflammation and insulin resistance. Therefore, LPL may represent a link between low adiponectin levels and dyslipidemia in both nondiabetic individuals and patients with type 2 diabetes.     

Relationship between adiponectin, glycemic control and blood lipids in diabetic type 2 postmenopausal women with and without complication of ischemic heart disease

BACKGROUND: Recently major adipocytokine, adiponectin, are thought to play important roles in the regulation of cardiovascular and metabolic homeostasis. We compared serum adiponectin concentrations and lipid profile in diabetic patients with and without complication of cardiovascular disease in postmenopausal women. METHODS: We included 120 female subjects between the age of 45 and 60 years. The subjects were divided into 3 groups and each group comprised of 40 subjects. First group comprised of normal healthy controls, second group diabetic type 2 patients with no history of ischemic heart disease (IHD) and the third group diabetic patients with IHD. Serum adiponectin concentrations, serum triglycerides, cholesterol, LDL cholesterol and HDL cholesterol concentrations were determined. RESULTS: Values of fasting and random blood glucose, serum triglycerides, cholesterol, LDL cholesterol were significantly increased (P<0.001) in diabetic patients with IHD as compared with normal control subjects except for serum adiponectin and HDL cholesterol concentrations, which were significantly decreased (P<0.001) in diabetic patients and diabetic patients with IHD group. When values of cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, fasting and random blood glucose and adiponectin were compared among diabetic and diabetic patients with IHD, it was observed that they were significantly increased (P<0.001) except for adiponectin, which was decreased significantly (P<0.001) and random blood glucose, LDL and HDL cholesterol in which no change was observed between the 2 groups. CONCLUSIONS: Serum adiponectin concentrations may be a predictor for development of cardiovascular disease in postmenopausal diabetic patients.