老年糖尿病患者颈动脉硬化的相关危险因素分析

目的 分析影响老年糖尿病患者颈动脉硬化的危险因素.方法 分析2015年7月-2020年6月安徽医科大学附属巢湖医院内分泌科门诊收治95例2型糖尿病患者的病例资料,根据是否存在颈动脉粥样硬化分为颈动脉粥样硬化组(n=56)和非颈动脉粥样硬化组(n=39).收集2组患者临床基本资料、体格检查结果、生化指标和颈动脉内-中膜厚...     

老年人颈动脉斑块形态学特点与心血管危险因素的相关性研究

目的 探讨老年人颈动脉狭窄程度及颈动脉斑块的形态学特点与心血管危险因素间的相关性.方法 选择我院行脑血管造影检查的老年患者321例,年龄60～83岁,参考颈动脉彩色超声检查结果,分为颈动脉粥样硬化组(斑块组)和颈动脉正常对照组,分析与年龄、性别、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密...     

老年人颈动脉斑块形态学特点与心血管危险因素的相关性研究

目的 探讨老年人颈动脉狭窄程度及颈动脉斑块的形态学特点与心血管危险因素间的相关性.方法 选择我院行脑血管造影检查的老年患者321例,年龄60～83岁,参考颈动脉彩色超声检查结果,分为颈动脉粥样硬化组(斑块组)和颈动脉正常对照组,分析与年龄、性别、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸、C-反应蛋白(CRP)、同型半胱氨酸(HCY)、高血压、糖尿病、吸烟、饮酒等心血管病危险因素的相关性.斑块组按颈动脉狭窄程度、斑块表面光顺度等与心血管危险因素进行相关性分析.并随访1年,前瞻性分析各亚组患者心、脑血管事件发生情况.结果 斑块组256例,对照组65例,斑块组TC、LDL-C、尿酸、CRP、吸烟、饮酒、高血压、糖尿病等心血管危险因素均高于对照组;在亚组分析中,年龄、吸烟和糖尿病与颈动脉狭窄程度呈正相关,而CRP、LDL-C、吸烟、糖尿病与颈动脉斑块表面光顺度相关.斑块组46例(18.0%)发生脑血管事件,32例(12.5%)发生心血管事件,颈动脉狭窄程度与脑血管事件呈正相关,而与心血管事件发生差异无统计学意义.颈动脉斑块表面光顺度与心、脑血管事件均呈正相关.结论 老年人颈动脉粥样硬化斑块的发生、发展与心血管危险因素关系密切,颈动脉斑块表面光顺度形态学特点在一定程度上较狭窄程度更能反应老年人动脉粥样硬化水平,并与心、脑血管事件的发生密切相关.     

老年人颈动脉斑块形态学特点与心血管危险因素的相关性研究

目的 探讨老年人颈动脉狭窄程度及颈动脉斑块的形态学特点与心血管危险因素间的相关性.方法 选择我院行脑血管造影检查的老年患者321例,年龄60～83岁,参考颈动脉彩色超声检查结果,分为颈动脉粥样硬化组(斑块组)和颈动脉正常对照组,分析与年龄、性别、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸、C-反应蛋白(CRP)、同型半胱氨酸(HCY)、高血压、糖尿病、吸烟、饮酒等心血管病危险因素的相关性.斑块组按颈动脉狭窄程度、斑块表面光顺度等与心血管危险因素进行相关性分析.并随访1年,前瞻性分析各亚组患者心、脑血管事件发生情况.结果 斑块组256例,对照组65例,斑块组TC、LDL-C、尿酸、CRP、吸烟、饮酒、高血压、糖尿病等心血管危险因素均高于对照组;在亚组分析中,年龄、吸烟和糖尿病与颈动脉狭窄程度呈正相关,而CRP、LDL-C、吸烟、糖尿病与颈动脉斑块表面光顺度相关.斑块组46例(18.0%)发生脑血管事件,32例(12.5%)发生心血管事件,颈动脉狭窄程度与脑血管事件呈正相关,而与心血管事件发生差异无统计学意义.颈动脉斑块表面光顺度与心、脑血管事件均呈正相关.结论 老年人颈动脉粥样硬化斑块的发生、发展与心血管危险因素关系密切,颈动脉斑块表面光顺度形态学特点在一定程度上较狭窄程度更能反应老年人动脉粥样硬化水平,并与心、脑血管事件的发生密切相关.     

Efficacy analysis of the lipid-lowering and renoprotective effects of rosuvastatin in patients with chronic kidney disease

We aimed to assess the effects of rosuvastatin treatment on lipid levels, albuminuria, and kidney function in patients with chronic kidney disease (CKD). We conducted a prospective, open-label, study of 91 patients with CKD, low-density lipoprotein cholesterol (LDL-C) levels > 120 mg/dL, and well-controlled blood pressure who were undergoing treatment with renin-angiotensin system inhibitors. Subjects were treated with 2.5 mg/day rosuvastatin, which was increased to 10 mg/day for the 24-week study period. Rosuvastatin effectively reduced total cholesterol, LDL-C, triglycerides, non-high density lipoprotein cholesterol (non-HDL-C) levels, and the LDL-C/HDL-C ratio. Although there was no significant change in the estimated glomerular filtration rate (eGFR), serum cystatin C levels and urinary albumin/creatinine ratio were significantly decreased. Subjects were divided into 2 groups: with and without diabetes mellitus (DM). Percent changes of HDL-C, C-reactive protein (CRP), and malondialdehyde-modified (MDA)-LDL were significantly higher in the DM group than in the non-DM group. Furthermore, when the subjects were divided into 2 groups based on eGFR levels (60 mL/min/1.73 m(2) or more, normal-GFR group; less than 60 mL/min/1.73 m(2), decreased-GFR group), the percent reduction of non-HDL-C, CRP, MDA-LDL levels, and albuminuria of DM subjects in the decreased-GFR group were significantly higher than those in the non-DM subjects. Multivariate analysis identified a change in cystatin C to be associated with decreased albuminuria during rosuvastatin treatment. Rosuvastatin administration reduced albuminuria, serum cystatin C levels, and inflammation, and improved lipid profiles, regardless of the presence or absence of DM, and the degree of the eGFR.     

男性2型糖尿病血尿酸与颈动脉粥样硬化的相关性研究

目的 探讨男性2型糖尿病患者血尿酸(SUA)水平和颈动脉粥样硬化的关系.方法 收集男性2型糖尿病患者579例,根据SUA水平四分位数分为:95~250、251~302、303~363和364~658 μmol/L 4个组.检测体重指数、血压、血脂、尿素氮、肌酐、HbA1C等相关指标,高分辨血管外超声检测颈动脉血管斑块厚度及颈动脉内膜中层厚度,统计学分析SUA与上述指标的关系.结果 男性2型糖尿病患者随着SUA水平升高颈动脉粥样硬化的检出率逐渐增高(P＜0.05),且斑块厚度也随之逐渐增高(P＜0.05),但与颈动脉内膜中层的厚度无关(P＞0.05).男性2型糖尿病患者年龄、SUA及HbA1C均为颈动脉粥样硬化的危险因素.结论 SUA与颈动脉粥样硬化发生发展可能有关.

Abstract：

Objective To investigate the relationship between the level of serum uric acid(SUA) and carotid atherosclerosis in male patients with type 2 diabetes mellitus(T2DM). Methods A collection of 579 male T2DM patients with or without carotid atherosclerosis were grouped based on quartiles of SUA. Age, SUA, smokers, duration, body mass index(BMI), blood pressure, total cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), blood urea nitrogen(BUN), creatinine(Cr), and HbA1C were determined in all subjects. The plaques in carotid arteries and intima-media thickness(IMT) were measured with high-resolution ultrasound. Results BMI, systolic and diastolic blood pressures, TG, and Cr showed a gradual increase, while HDL-C and HbA1C showed a gradual decrease according to the higher SUA quartiles in male T2DM(P＜0.05). Nevertheless, the detectable rates of smokers, duration, age, TC, LDL-C, and BUN had no relationships with the SUA quartiles(P＞0.05). The detectable rate of carotid atherosclerosis and the thickness of carotid plaque were positively associated with the levels of SUA in male patients with T2DM(P＜0.05). However, intima-media thickness of carotid arteries did not illustrate the correlation with the levels of SUA in male T2DM patients(P＞0.05). Age, HbA1C, and SUA were independent factors of carotid atherosclerosis in these patients by logistic regression(P＜0.05). Conclusion The levels of SUA seems to be associated with the occurrence and development of carotid atherosclerosis in male patients with T2DM.     

Association between apolipoprotein E polymorphism and subclinic atherosclerosis in patients with type 1 diabetes mellitus

Objective The most important cause of morbidity and mortality in type 1 diabetes mellitus (DM) is atherosclerosis. Apolipoprotein E (Apo E) polymorphism is accused of being the genetic risk factor for atherosclerosis. The aim of the present study was to determine which Apo E polymorphism was related to atherosclerosis in patients with type 1 DM.Methods: Seventy-four patients with type 1 DM were enrolled in the study. Age, diabetes duration, daily insulin dose, microalbuminuria, and major cardiovascular risk factors including anthropometric and metabolic parameters were assessed in each patient. Non-invasive ultrasonographic measurements were also performed. For determination of Apo E genotype, DNA was extracted from venous blood from all subjects using standard methods. Apo E genotyping was performed using a PCR–restriction fragment-length polymorphism assay.Results: Systolic blood pressure and carotid artery intima-media thickness (CA-IMT) were increased in subjects with E4/E4 polymorphism. According to univariate analysis, when adjusted for all risk factors, genotypes did not differ for total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides (p>0.05). However, E3/E3, E3/E4 and E4/E4 genotypes were found to be associated with an increase in CA-IMT (p<0.001).Conclusions: Our results suggest that the polymorphism associated with atherosclerosis in type1 DM is Apo E4/E4.Conflict of interest:None declared.     

藏族人群高血糖症与颈动脉粥样硬化的关系

目的:探讨藏族人群高血糖症与颈动脉粥样硬化的关系。方法:以拉萨市藏族人群为研究对象,进行临床调查、生化检查和颈动脉检查。检查并分析449例藏族人的糖耐量,糖基化血红蛋白、血压、血脂、空腹胰岛素含量和颈总动脉内中膜厚度。结果:根据糖耐量试验的结果,将研究对象分为3组:正常糖耐量组(NGT)352例,糖耐量低减组(IGT)62例,糖尿病组(DM)35例。患者糖耐量异常的程度越高,患者年龄越大(P<0.01),高血压发病率越高(P<0.05),胰岛素抵抗指数(HOMA-IR)越大(P<0.001),糖基化血红蛋白值越高(P<0.01),血糖(P<0.001)、甘油三酯浓度(P<0.05)越高,高密度脂蛋白-胆固醇水平越低(P<0.05)。IGT和DM组的颈动脉粥样硬化程度远比NGT组严重(P<0.001)。多元回归分析表明,增龄、胆固醇、甘油三酯、低密度脂蛋白、糖基化血红蛋白和胰岛素抵抗指数的自然对数ln(HOMA-IR)是颈动脉粥样硬化的独立危险因素(P<0.05)。结论:高糖血症的藏族人群动脉粥样硬化程度严重。糖基化血红蛋白、增龄、血脂异常、胰岛素抵抗是颈动脉粥样硬化的重要因素。     

The lipid triad in type 2 diabetes - prevalence and relevance of hypertriglyceridaemia/low high-density lipoprotein syndrome in type 2 diabetes.

Cardiovascular disease is the major cause of morbidity and mortality in type 2 diabetes mellitus. Among the established risk factors, the lipid triad (elevated triglycerides, decreased high-density lipoprotein cholesterol, and small dense low-density lipoprotein cholesterol) is a powerful risk factor for atherosclerosis in type 2 diabetes. The prevalence of hypertriglyceridaemia (HTG) in type 2 diabetes is two to three times higher than in non-diabetics. The Copenhagen Male study, the AMORIS study, and several other trials showed hypertriglyceridaemia to be an independent predictor of coronary heart disease (CHD). HTG may promote risk both directly and indirectly through association with alterations of lipoprotein size and composition. The Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA-HIT) demonstrated that raising high-density lipoprotein cholesterol (HDL-C) in patients with low (HDL-C) and low-density lipoprotein cholesterol (LDL-C) is associated with a significant reduction in CHD risk. It was shown in the Diabetes Intervention Study, AFCAPS/TexCAPS, and PROCAM studies that decreased HDL-C and elevated triglycerides are independent risk factors for atherosclerosis, particularly in patients with diabetes mellitus. Several epidemiological studies demonstrated that total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratios or low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratios could be better predictors of atherosclerosis than any single lipid parameter. Intima-media thickness (IMT), a well established marker of early atherosclerosis, is associated with HTG/low HDL-cholesterol. In the Risk factors in IGT for Atherosclerosis and Diabetes (RIAD) study total and HDL-cholesterol were independent determinants of IMT in subjects at risk for type 2 diabetes. Postprandial HTG was also shown to be correlated with increased IMT in type 2 diabetic patients.     

Cardio-ankle vascular index value in dyslipidemia patients affected by cardiovascular risk factors

Background: Increased arterial stiffness is an independent cardiovascular risk factor in smokers or patients with diabetes mellitus and hypertension. Cardio-ankle vascular index (CAVI) is an index of arterial stiffness and atherosclerosis. One of the most important risk factors of the causes of atherosclerosis is dyslipidemia(DLP). However, there was a little research about which influence factors such as: hypertension, diabetes mellitus, and smoking could contribute to the atherosclerosis in the subjects withDLP. Methods: A total of 649 subjects with DLP (Male328/Female321) from Vascular Medicine of Peking University Shougang Hospital were examined, with a median age of 66 and 5–95 percentile range 47.0–83.5 years. Fasting plasma glucose (FPG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglyceride (TG) were analyzed by colorimetric enzymatic assays with the use of an auto analyzer (HITACHI-7170, Hitachi, Tokyo, Japan).CAVI was measured by VS-1000 apparatus. Results: CAVI correlated significantly with age (p<0.001), Systolic (p<0.001) blood pressure(BP), Total cholesterol (p<0.001), LDL-cholesterol (p<0.001),Triglycerides (p<0.001) . There was no significant difference in CAVI between smokers and non-smokers (p = 0.08) and between statin-treated subjects than in those without statins (p = 0.247). CAVI was significantly higher in subjects with hypertension than in the normotensive group (p<0.001) and in mellitus subjects than in those without mellitus (p<0.001);however, CAVI values adjusted for age was higher only in hypertension than in the normotensive group (p<0.001). Conclusions: Our study demonstrated that CAVI value in DLP patients is not significantly affected by diabetes mellitus and smoking, but is increased by hypertension.     

Metabolic syndrome amplifies the LDL-cholesterol associated increases in carotid atherosclerosis

OBJECTIVE: Carotid intima-media thickness (IMT) is a useful surrogate marker of cardiovascular disease. In addition to low-density lipoprotein cholesterol (LDL-C), metabolic syndrome has been linked to the pathogenesis of atherosclerosis. The present study investigated whether the clustering of multiple components of metabolic syndrome has a greater impact on vascular parameters than individual components of metabolic syndrome, and assessed the association between carotid IMT and LDL-C and metabolic syndrome. METHODS: Carotid IMT was evaluated on B-mode ultrasonography in 760 patients (340 men aged 64+/-16 years and 420 women aged 69+/-13 years) in the Medical Department of Seiyo Municipal Nomura Hospital. The subjects did not demonstrate any clinical signs of cardiovascular disease. We investigated the association between carotid IMT and confounding risk factors including LDL-C and metabolic syndrome using the 2005 Japanese criteria. RESULTS: Carotid IMT increased with increasing numbers of metabolic syndrome components (p for trend<0.001). Multiple regression models, including age, sex, body mass index, smoking status, LDL-C, diabetes mellitus as well as each individual component of metabolic syndrome as continuous variables, showed that both metabolic syndrome (beta=0.100; p=0.029) and LDL-C (beta=0.210, p<0.001) were independent determinants of carotid IMT. Metabolic syndrome amplified the LDL-C associated increases in carotid atherosclerosis. CONCLUSIONS: Even after taking into account each individual component of MS, the clustering of visceral obesity with at least 2 of the 3 components, and LDL-C are independently associated with increased carotid IMT. This suggests that the components of metabolic syndrome interact to synergistically impact vascular thickness.     

Predictive value of lipoprotein (a) and other serum lipoproteins in the angiographic diagnosis of coronary artery disease

To determine the relation among lipids in predicting coronary artery disease (CAD), 213 patients undergoing diagnostic angiography for suspected CAD were prospectively studied. Twenty-one patients had normal coronary arteries and 192 had CAD in 1 to 3 arteries at arteriography with measurements obtained with digital calipers. Lipoproteins were measured and lipoprotein (a) [Lp(a)] was also assayed in a subset of 98 patients with CAD. Statistical analysis was performed using uni- and multivariate techniques to test the association among age, gender, systemic hypertension, diabetes mellitus, cigarette smoking, family history, total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, very low density lipoprotein cholesterol, apolipoproteins (apo) A-I and apo B, ratio of apo A-I to apo B, and ratio of HDL cholesterol to total cholesterol, to Lp(a) and to CAD. All factors except gender, systemic hypertension, diabetes mellitus and cigarette smoking were univariate predictors of CAD. Multivariate predictors were, in decreasing order of significance, family history, age, HDL/total cholesterol ratio and apo B. When Lp(a) was included, multivariate predictors were age, family history, apo B and Lp(a), in that order. Lipid parameters alone showed that the HDL/total cholesterol ratio and that Lp(a) provide the best predictive tests for the detection of CAD in this referral population and may ultimately become important screening tests for CAD.     

Association between plasma lipids, and apolipoproteins and coronary artery disease: a cross-sectional study in a low-risk Korean population

BACKGROUND: Due to the lower level of the traditional lipid profiles in Koreans than in the series of patients from the western countries, the need to investigate other lipid parameters to help identify the individuals at high risk of CAD has been emphasized. AIM AND METHODS: To investigate whether apolipoprotein B (apo B), apolipoprotein A-I (apo A-I) and their ratio give additional information to the traditional lipid risk factors for discriminating the individuals at high-risk for coronary artery disease (CAD), 544 subjects, who met the lipid criteria of total cholesterol (TC) <230 mg/dl, low-density lipoprotein cholesterol (LDL-C) <120 mg/dl and high-density lipoprotein cholesterol (HDL-C) >40 mg/dl were recruited. Patients were considered to be CAD(+) if they had > or =50% stenosis in at least one coronary artery. RESULTS: In men, TC and apo B/apo A-I ratio were significantly different between groups with and without CAD after adjusting for age and diabetes (P = 0.037 and 0.035), and in women, triglyceride (TG), HDL-C and apo B/apo A-I ratio were significantly different after adjusting for age, diabetes and smoking status (P = 0.006, 0.007 and 0.030, respectively). In the lowest quartile of TC, TG and LDL-C, and the highest quartile of HDL-C, only apo B/apo A-I ratio was associated with CAD in both men and women. The only variable showing a significant difference between patients with and without CAD was apo B/apo A-I ratio. In models assessing whether apolipoproteins give additional information to traditional lipid risk factors, HDL-C, LDL-C, apo B/apo A-I ratio and in women but not in men, TG and apo B were all independent markers for the presence of CAD. Among the nontraditional lipid factors, only apo B/apo A-I ratio showed its additional value for identifying the presence of CAD. CONCLUSION: Apo B/apo A-I ratio is the only variable that differentiates the patients with CAD from those without and, furthermore, gives additional information to that supplied by traditional lipid risk factors in a low-risk Korean population.     

Adiponectin is independently associated with apolipoprotein B to A-1 ratio in Koreans

Apolipoprotein B to A-1 (apo B/A-1) ratio is reportedly a better predictor of atherosclerotic vascular disease than low-density lipoprotein cholesterol (LDL-C). The aim of this study was to assess the association of serum apo B/A-1 ratio with insulin resistance and adiponectin in patients with different grades of glucose intolerance. Patients were divided according to glucose tolerance into 3 groups: normal glucose tolerance without metabolic syndrome (n = 229), impaired fasting glucose (subjects with fasting plasma glucose level between 100 and 125 mg/dL, n = 658), and type 2 diabetes mellitus (n = 381). Serum concentrations of apo B, apo A-1, glucose, total cholesterol (TC), triglycerides, and high-density lipoprotein cholesterol (HDL-C) and adiponectin were measured. Insulin resistance was estimated by the homeostasis model assessment of insulin resistance index (HOMA-IR). There were significant differences in metabolic parameters among the groups, including waist circumference, insulin, HOMA-IR, and apo B/A-1 ratio, which increased sequentially with glucose intolerance, whereas adiponectin level decreased with increasing severity of glucose intolerance. The apo B/A-1 ratio was significantly correlated with TC, triglycerides, LDL-C, HDL-C, adiponectin, and HOMA-IR in normal glucose tolerance, impaired fasting glucose, and type 2 diabetes mellitus. Multiple regression analysis showed that apo B/A-1 ratio was significantly associated with TC, LDL-C, HDL-C, and adiponectin. In conclusion, apo B/A-1 ratio was significantly associated with insulin resistance according to glucose intolerance; and serum adiponectin was an important independent factor associated with apo B/A-1 ratio in Koreans.     

新疆地区高血压患者血浆同型半胱氨酸水平与颈动脉粥样硬化的关系研究

目的探讨新疆维吾尔族和汉族高血压患者血浆同型半胱氨酸(Hcy)水平与颈动脉内膜中层厚度(IMT)及颈动脉粥样硬化之间的关系。方法入选2011年至2015年期间在新疆医科大学第一附属医院老年病科住院的原发性高血压患者420例,入选同期入院的健康体检人群405例作为对照。依据研究对象的民族及是否患有高血压分为4组:维吾尔族高血压组(n=206),维吾尔族对照组(n=202),汉族高血压组(n=214)和汉族对照组(n=203)。采用酶联免疫吸附实验测定血浆Hcy水平,彩色多普勒超声测定颈动脉IMT。结果民族内比较结果显示,相比对照组,高血压组体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、Hcy水平高,叶酸(FA)水平低,颈动脉IMT增厚,粥样硬化斑块发生率高,差异均具有统计学意义(P0.05)。民族间比较结果显示,维吾尔族和汉族高血压患者间年龄、性别、尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、FA、维生素B_(12)、Hcy水平、颈动脉IMT和粥样硬化斑块发生率差异无统计学意义(P0.05)。Hcy与年龄、TC、LDL-C、SBP呈正相关,与FA呈负相关。颈动脉IMT与年龄、TC、LDL-C、SBP、Hcy呈正相关,与FA呈负相关。结论高Hcy血症、年龄、TC、LDL-C是新疆维吾尔族和汉族高血压患者颈动脉粥样硬化的危险因素。     

Ⅱ型糖尿病合并高血压对脂代谢及胰岛素敏感性的影响

目的：观察Ⅱ型糖尿病合并高血压对脂代谢及胰岛素敏感性的影响。方法：对20例Ⅱ型糖尿病合并高血压患者和20例Ⅱ型糖尿病无高血压患者的空腹血糖（FBG）,血脂,胰岛素（FINS）,C肽（FCP）,胰岛素敏感指数（ISI）进行对照,结果：Ⅱ型糖尿病合并高血压组与无高血压组比较,甘油三酯（TG）,FINS,FCP水平显著升高（P＜0．05）,高密度脂蛋白（HDL）,ISI水平显著降低（P＜0．05）,结论：Ⅱ型糖尿病合并高血压时脂代谢紊乱及胰岛素抵抗更加明显。     

Low-density lipoprotein size and subclasses are markers of clinically apparent and non-apparent atherosclerosis in type 2 diabetes

The atherogenic lipoprotein phenotype is characterized by an increase in plasma triglycerides, a decrease in high-density lipoprotein (HDL), and the prevalence of small, dense low-density lipoprotein (LDL) particles. The present study investigated the clinical significance of LDL size and subclasses as markers of atherosclerosis in diabetes type 2. Thirty-eight patients with type 2 diabetes, total cholesterol of less than 6.5 mmol/L, and hemoglobin A1c (HbA1c) of less than 9% were studied. Median age was 61 years, mean (+/-SD) body mass index 29 +/- 4.3 kg/m2 , and mean HbA1c 7.1 +/- 0.9 %. Laboratory parameters included plasma lipids and lipoproteins, lipoprotein (a), apolipoprotein (apo) A-I, apo B-100, apo C-III, and high-sensitivity C-reactive protein. Low-density lipoprotein size and subclasses were measured by gradient gel electrophoresis and carotideal intima media thickness (IMT) by duplex ultrasound. By factor analysis, 10 out of 21 risk parameters were selected: age, body mass index, systolic blood pressure, smoking (in pack-years), HbA1c, high-sensitivity C-reactive protein, lipoprotein (a), LDL cholesterol, HDL cholesterol, and LDL particle size. Multivariate analysis of variance of these 10 risk parameters identified LDL particle size as the best risk predictor for the presence of coronary heart disease (P = .002). Smaller LDL particle size was associated with an increase in IMT (P = .03; cut-off >1 mm). Within the different lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, apo B, apo A-I, apo C-III, LDL particle size), LDL particle size was most strongly associated with the presence of coronary heart disease (P = .002) and IMT (P = .03). It is concluded that LDL size is the strongest marker for clinically apparent as well as non-apparent atherosclerosis in diabetes type 2.     

代谢综合征患者颈动脉内膜-中层厚度变化及与动脉粥样硬化程度的关系

目的探讨代谢综合征(MS)患者颈动脉内膜-中层厚度(CAMT)的改变,及其与各种危险因素的关系。方法51例代谢综合征患者,按其血糖水平分为糖耐量减低(MS-IGT)组27例和2型糖尿病(MS-DM)组24例;另选25例健康者为对照组。均行超声检查,测定CAMT,并做血脂、血糖等检查。结果代谢综合征组CAMT高于对照组(P<0.01)。CAMT与年龄、收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、空腹血糖(FPG)、餐后2h血糖(2hPG)、空腹胰岛素(FINS)、2h胰岛素(2hINS)、血总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白-B(Apo-B)呈正相关(P<0.01)。多元逐步回归分析,年龄、SBP、DBP、BMI、FPG、2hPG、2hINS、TC、LDL-C与CAMT关系较为密切。结论代谢综合征患者可加速动脉粥样硬化的进展。CAMT能在早期反映高血压、高血糖和高血脂对动脉粥样硬化的促进作用。     

Syndrome of impaired tolerance to dietary fats in coronary heart disease

Changes of main lipid and apolipoprotein parameters of lipid transport system during postprandial hyperlipidemia were studied in subjects without (n=72) and with (n=167) overt coronary heart disease (CHD) including patients with noninsulin dependent diabetes (n=48). Tolerance to dietary fat was evaluated by oral fat load test (consumption of 639+/-7 ml of 20% cream after fast). In subjects without CHD reaction of lipid transport system to fat load was characterized by lowered total, low density lipoprotein cholesterol, apolipoprotein apo B and apo B/apo A-1 ratio, lowered or unchanged triglycerides, stable high density lipoprotein cholesterol level at the background of apo A-1 elevation by 6-th hour after load. Patients with CHD exhibited signs of impaired tolerance to dietary fat: elevation of triglycerides, apo B and apo B/apo A-1 ratio, lowering of high density lipoprotein cholesterol, increase of percentage of subfractions of small high density lipoproteins particles, increase of triglyceride content in low and high density lipoprotein fraction during 6 hours after fat load.     

Association between plasma angiopoietin-like protein 3 and arterial wall thickness in healthy subjects

BACKGROUND: Angiopoietin-like protein 3 (ANGPTL3) is a liver-derived plasma protein that modulates plasma triglyceride clearance, angiogenesis and atherosclerosis in experimental models. So far, no study has examined its role in atherosclerosis in human subjects. We evaluated the possible association between plasma ANGPTL3 level and carotid artery intima-media thickness (CA-IMT) and femoral artery intima-media thickness (FA-IMT) in healthy human subjects. METHODS: The subjects were 381 healthy volunteers. Plasma ANGPTL3 was determined by a specific ELISA. CA-IMT and FA-IMT were measured by high-resolution B-mode ultrasonography. RESULTS: The plasma ANGPTL3 level was 764 +/- 291 ng/ml (mean +/- SD). CA-IMT showed a significant positive correlation with plasma ANGPTL3 and other classical risk factors such as age, blood pressure, and plasma glucose and lipid levels. The positive association between ANGPTL3 and CA-IMT remained significant after adjustment for age, sex, smoking, body mass index, systolic blood pressure, plasma glucose, insulin resistance index, triglyceride, and high-density and low-density lipoprotein cholesterol levels. ANGPTL3 also showed a positive association with FA-IMT independent of these factors. CONCLUSIONS: These results demonstrate for the first time that ANGPTL3 is closely associated with arterial wall thickness in human subjects.