Usefulness of lipoprotein ratios in assessing carotid atherosclerosis in Japanese type 2 diabetic patients
Introduction
Cardiovascular disease (CVD) based on atherosclerosis is the most important cause of mortality in subjects with type 2 diabetes mellitus (T2DM). T2DM is characterized by a clustering of CVD risk factors, such as dyslipidemia, hypertension, obesity, and insulin resistance as well as hyperglycemia. Among these factors, dyslipidemia may play a primary role in the development of atherosclerotic vascular disease and subsequent death due to the disease [1]. Since many observational and interventional studies have demonstrated that low-density lipoprotein (LDL) is the primary atherogenic lipoprotein [2], [3], [4] and that high-density lipoprotein (HDL) is the predominant anti-atherosclerotic lipoprotein [5], measurements of total cholesterol (TC), LDL cholesterol (LDL-C), and HDL cholesterol (HDL-C) are widely recommended [1], [6]. However, there is a growing evidence suggesting that non-HDL cholesterol (non-HDL-C), defined as the difference between TC and HDL-C to include all atherogenic apoB-containing lipoproteins, is a better tool for assessing the risk of CVD [7], [8], [9], [10], [11]. Also, some studies suggest that TC/HDL-C and LDL-C/HDL-C ratios are risk indicators with greater predictive value than each parameter used independently [12], [13], [14]. However, there are limited data comparing the utility of non-HDL-C and these lipoprotein ratios simultaneously with conventional lipid measurements in detecting subclinical early-stage atherosclerosis in type 2 diabetic patients.
In this study, therefore, we evaluated the association between these lipid parameters and carotid atherosclerosis, since carotid atherosclerotic lesions are practically easy to evaluate noninvasively with ultrasonography and measurements of intima-media thickness (IMT) have been demonstrated to be strong indicators of subclinical atherosclerosis and future cardiovascular risk in subjects with and without T2DM [15], [16].
Section snippets
Subjects
The subjects were selected from the outpatients at 2 participating hospitals (Osaka University Medical Hospital and Naka Memorial Clinic) in Japan as follows. Japanese type 2 diabetic subjects who periodically attended the outpatient clinics of diabetes were asked whether they would participate in the study. We considered subjects eligible when they had T2DM diagnosed by diabetologists based on World Health Organization criteria. Those who had history of CVD or connective tissue disease and
Association between lipid measurements and carotid IMT
After exclusion of 2 patients with triglyceride levels ≥400 mg/dl, a total of 932 subjects were included in the analysis (Table 1). Among 932 study subjects, 467 were defined as having dyslipidemia based on the Japan Atherosclerosis Society's criteria (LDL-C ≥ 120, HDL-C < 40, or TG ≥ 150).
In univariate correlation analysis, IMT was significantly correlated with HDL-C levels, TC/HDL-C and LDL-C/HDL-C ratios (Table 2). IMT was also correlated with gender, age, duration of diabetes, systolic blood
Discussion
In this study, we examined the relation between various lipid parameters and carotid atherosclerosis evaluated by ultrasonography in type 2 diabetic subjects without CVD and obtained direct comparative data. IMT appears to be most closely associated with TC/HDL-C and LDL-C/HDL-C ratios among various lipid parameters tested even after adjustment of the other non-lipid variables in multiple regression analysis. Also, these two ratios showed a positive and linear association with the prevalence of
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