ArticlePDF Available

Prevalence and pattern of diabetic dyslipidemia in Indian type 2 diabetic patients

Authors:
Rakesh Parikh
Rakesh Parikh
Shashank Joshi at Lilavati Hospital and Research Centre
Shashank Joshi
Padmavathy Menon at King Edward Memorial Hospital
Padmavathy Menon
Nalini Shah at King Edward Memorial Hospital
Nalini Shah
Download full-text PDF
Read full-text
Download citation

Abstract

AimTo study prevalence and pattern of dyslipidemia in Indian type 2 diabetic patients.
Content uploaded by Shashank Joshi
Author content
All content in this area was uploaded by Shashank Joshi on Jul 27, 2021
Content may be subject to copyright.
Original paper
Prevalence and pattern of diabetic dyslipidemia in Indian type 2 diabetic patients
Rakesh M. Parikh
a,
*, Shashank R. Joshi
b
, Padmavathy S. Menon
c
, Nalini S. Shah
c
a
Department of Diabetology, S K Soni Hospital, Jaipur, India
b
Department of Endocrinology, Lilawati Hospital, Mumbai, India
c
Department of Endocrinology, Seth G S Medical College & K E M Hospital, Mumbai, India
1. Introduction
Coronary artery disease (CAD), which is the most common
cause of mortality in diabetic patients, is strongly associated with
increased levels of serum low-density lipoproteins (LDL) [1].
Numerous studies have shown the reduction in cardiovascular
morbidity and mortality with statin therapy, which can be
attributed to the lowering of LDL cholesterol in addition to
pleotrophic effects of statins. In spite of advancement in our
therapeutic armamentarium, there has not been much reduction in
cardiovascular mortality in diabetic patients comparable to that in
non-diabetic [2]. Diabetic patients are known to have high levels of
serum triglyceride (TG) and low levels high-density lipoproteins
(HDL). Low levels of serum HDL might be the missing link, which
also has shown to have a strong correlation with cardiovascular
disease [3,4]. American Diabetes Association (ADA) guidelines
recommend maintaining serum levels of TG below 150 mg/dl, LDL
cholesterol below 100 mg/dl and HDL cholesterol of more than
40 mg/dl in males and 50 mg/dl in females [5]. In our experience
we found very few patients with HDL cholesterol of more than
50 mg/dl, provoking us to look at lipid profile pattern among our
patients. We did not find any study from Indian subcontinent
looking at pattern of dyslipidemia in large number of diabetic
patients. Present study was aimed at analyzing lipid profiles of our
patients with a special emphasis on role of each parameter
separately in causing dyslipidemia.
2. Study design and methodology
2.1. Study design
Records of diabetic patients who have visited our clinic during
preceding 6 months were considered for retrospective analysis. In
descending order of their registration number total of 1086 records
were studied. A note was made regarding the type of diabetes, last
HbA1C, last lipid profile (TC, TG, HDL, LDL) of the patient, in
addition to the pharmacologic treatment (s)he was on. Patients
Diabetes & Metabolic Syndrome: Clinical Research & Reviews 4 (2010) 10–12
ARTICLE INFO
Keywords:
Diabetes mellitus
Type 2
Dyslipidemia
India
ABSTRACT
Aim:
To study prevalence and pattern of dyslipidemia in Indian type 2 diabetic patients.
Materials and methods: Fasting serum lipid profiles of 788 consecutive patients with type 2 diabetes
were retrieved from hospital records. Patients having one or more parameters (TG, HDL cholesterol or
LDL cholesterol) outside the targets recommended by American Diabetes Association (ADA) were
considered to have dyslipidemia. Those with dyslipidemia were further classified into mixed
dyslipidemia, combined two parameter dyslipidemia and isolated single parameter dyslipidemia (TG,
HDL or LDL).
Results: Prevalence of dyslipidemia among diabetic patients at baseline was 85.5% among males and
97.8% among females. Among the males with dyslipidemia the proportion of patients with mixed
dyslipidemia, combined dyslipidemia and single parameter dyslipidemia were 14.1%, 44.9% and 41%,
respectively. Figures for the same among female patients stood at 24.6%, 47.8% and 27.7%, respectively.
Combined dyslipidemia with high LDL and low HDL was the most common pattern among males and
females both, contributing to 22.7% and 33% patients of diabetic dyslipidemia, respectively. Second most
common pattern among males was isolated high LDL, contributing to 21.3% of males with dyslipidemia.
While among females isolated low HDL emerged as the second most common pattern affecting 13.4%
dyslipidemic females.
Conclusions: Majority of Indian type 2 diabetic patients are dyslipidemic at baseline. The most common
pattern of dyslipidemia is high LDL and low HDL among both males and females. The most prevalent
problem among males is high LDL while among females low HDL emerged as a bigger threat.
ß2009 Diabetes India. Published by Elsevier Ltd. All rights reserved.
* Corresponding author at: C-56, Ramnagar, Shastrinagar, Jaipur 302016, India.
Tel.: +91 9351384427; fax: +91 1412303411.
E-mail address: drrakeshparikh@gmail.com (R.M. Parikh).
Contents lists available at ScienceDirect
Diabetes & Metabolic Syndrome: Clinical Research &
Reviews
journal homepage: www.elsevier.com/locate/dsx
1871-4021/$ – see front matter ß2009 Diabetes India. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.dsx.2009.04.005
with a clinical diagnosis other than type 2 DM and those with poor
glycemic control (HbA1C >10%) were excluded from the analysis.
The patients of primary dyslipidemia and those with serum TG of
more than 400 mg/dl were also excluded. As the study was aimed
at analyzing pattern of lipid profile at baseline, those who were on
lipid lowering drugs likes statins, ezetimibe, fibrates and niacin
were not included in the analysis.
2.2. Analysis
Patients with one or more parameters (TG, HDL Cholesterol or
LDL cholesterol) outside the targets recommended by ADA were
considered to have dyslipidemia. Patients with dyslipidemia were
further subdivided into those with mixed dyslipidemia (all
parameters outside the recommended targets), combined dysli-
pidemia (two parameters outside and one parameter within target
range) and those with isolated single parameter dyslipidemia (TG,
HDL or LDL). Among the patients with combined dyslipidemia
proportion of patients with different patterns (high TG and low
HDL; high TG and high LDL; high LDL and low HDL) was obtained.
3. Results
A total of 788 patients, 422 males and 366 females were
included in the analysis (Table 1).
3.1. Prevalence of dyslipidemia
361 out of 422 males (85.5%) had dyslipidemia, while the
prevalence was even higher among females affecting 358 out of
366 (97.8%) patients.
3.2. Pattern of dyslipidemia in males
Proportion of patients with combined dyslipidemia was highest
affecting 162 (44.9%) out of 361 dyslipidemic males. Isolated single
parameter dyslipidemia was seen in 148 (41%) patients, while 51
patients (14.1%) revealed a mixed pattern.
Among patients with combined dyslipidemia, 37 (10.3%)
patients had high TG with low HDL, 43 (12%) had high TG with
high LDL, while high LDL with low HDL was the most common
pattern affecting 82 (22.7%) patients.
Sub-analysis of males with isolated single parameter dyslipi-
demia revealed that 27 (7.5%) patients had isolated hypertrigly-
ceridemia, 44 (12.2%) patients had isolated low HDL while isolated
high LDL was seen in 77 (21.3%) patients.
Overall the most common pattern among males was combined
dyslipidemia, with High LDL and low HDL, followed by isolated
high LDL. Altogether 253 out of 361 (70.1%) males with
dyslipidemia had high levels of LDL cholesterol.
3.3. Pattern of dyslipidemia in females
Even among females, combined dyslipidemia was more
common involving 171 out of 358 (47.8%) dyslipidemic patients.
Unlike males the prevalence of mixed dyslipidemia and single
parameter dyslipidemia was comparable involving 88 (24.6%) and
99 (27.7%) patients, respectively.
Even in female patients, high LDL with low HDL was the most
common pattern of combined dyslipidemia involving 118 out of
358 (33%) patients, proportion being higher than that in males
(33% vs. 22.7%). 34 (9.5%) patients had high TG with low HDL while
only 19 (5.3%) had high TG with high LDL.
Unlike the pattern of single parameter dysliplidemia in males,
only 5 (1.4%) females had isolated hypertriglyceridemia. 46 (12.9%)
patients had isolated high LDL while the most common single
parameter dyslipidemia among females was low HDL affecting 48
(13.4%) females.
Combined dyslipidemia with high LDL and low HDL was the
most common pattern even among females. But unlike males the
second most common pattern was isolated low HDL. Overall low
HDL stood as the biggest problem affecting 288 out of 358 (80.4%)
females with dyslpidemia.
4. Discussion
Patients with type 2 DM show characteristic lipid profile of
normal or slightly raised LDL cholesterol, with low HDL and mildly
elevated TG concentration [6]. Measurements confined to LDL may
therefore underestimate the risk associated with the concentration
of atherogenic lipoprotein particles in diabetes [7]. Indeed in some
cohorts of patients with diabetes, total cholesterol and LDL
cholesterol levels did not associate with cardiovascular risk
whereas, high TG and low HDL cholesterol concentration were
powerful predictors of cardiovascular events [8]. Low HDL in
patients with metabolic syndrome can substantially raise TC/HDL
ratio, which was found to be the best lipid index for predicting
cardiovascular events in prospective studies such as Framingham
Heart Study and Quebec Cardiovascular Study [9]. All above
mentioned evidences suggest that targeting HDL is at least equally
or may even be more important than other components of lipid
profiles.
44 out of 422 (10.4%) males and 48 out of 366 (13.1%) females in
our cohort had low HDL as the only problem. Such patients who
satisfy all other lipid profile targets may be overlooked because of
unavailability of potent drug to increase HDL. In such patients HDL
should be targeted aggressively by advising exercise, or with drugs
like niacin. Targeting HDL becomes even more relevant among
females as 288 out of 366 (78.7%) type 2 diabetic females had low
HDL at baseline.
Average HDL levels in women are approximately 10 mg/dl
higher than in men [10]. Low levels of HDL <35 mg/dl in men and
<45 mg/dl in women, is associated with a greater risk of coronary
artery disease and more progression of angiographically demon-
strated disease in women, while increasing HDL has a more cardio
protective effect in the female than in the male population. The
total cholesterol (TC)/HDL ratio is also more predictive of coronary
artery disease in women than in men [10]. With this background,
the results of above study become more relevant.
Being a cross-sectional retrospective analysis this study has
limitations like lack of standardization in measurement of lipid
profile. Though patients with poor glycemic control were excluded,
exact glycemic status, which has implications on lipid profile,
could not be retrieved. But this study probably is the first such data
Table 1
Prevalence and pattern of dyslipidemia in type 2 diabetic males and females at
baseline (not on any lipid lowering agent).
Males (422) Females (366)
Mixed dyslipidemia
High TG, high LDL and low HDL 51 (12.1%) 88 (24.0%)
Combined dyslipidemia
High TG and low HDL 37 (8.8%) 34 (9.3%)
High TG and high LDL 43 (10.2%) 19 (5.2%)
High LDL and low HDL 82 (19.4%) 118 (32.2%)
Isolated single parameter dyslipidemia
High TG 27 (6.4%) 5 (1.4%)
High LDL 77 (18.2%) 46 (12.6%)
Low HDL 44 (10.4%) 48 (13.1%)
Total 361 (85.5%) 358 (97.8%)
TG, triglyceride; HDL, high-density lipoprotein; LDL, low-density lipoprotein.
R.M. Parikh et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 4 (2010) 10–12
11
from Indian subcontinent and might serve as a basis for
comparison from other parts of the country.
5. Conclusions
Majority of our diabetic patients failed to achieve all standard
goals of dyslipidemia management. In a substantial number of
patients this was attributable to the fact the HDL target was not
met. Hence, the standard of care demands that we ought to pursue
HDL goals more aggressively.
Conflicts of interest
No financial funding was received for the study and there are no
conflicts of interest.
References
[1] Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR, Holman
RR. Risk factors for coronary artery disease in non-insulin dependent diabetes
mellitus (UKPDS 23). Br Med J 1998;316:823–8.
[2] Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US
adults. J Am Med Assoc 1999;281:1291–7.
[3]RubinsHB,RobinsSJ,CollinsD,FyeCL,AndersonJW,ElamMB,FaasFH,
Linares E, Schaefer EJ, Schectman G, Wilt TJ, Wittes J. Gemfibrozil for the
secondary prevention of coronary heart disease in men with low levels of
high-density lipoprotein cholesterol: Veterans Affairs High-Density Lipo-
protein Cholesterol Intervention Trial Study Group. New Engl J Med 1999;
341:410–8.
[4] Steiner G. Dyslipoproteinaemias in diabetes. Clin Invest Med 1995;18:282–7.
[5] Dyslipidemia Management in Adults With Diabetes. Diabetes Care 2004;
27(Suppl. 1):S68–71.
[6] Bierman EL. Atherogenesis in diabetes. Arterioscler Thromb Vasc Biol 1992;
12:647–56.
[7] Poirier P, Despres JP, Lipid disorders in diabetes. In: Pickup JC, Williams G, eds.
Text book of diabetes, 3rd ed. vol. 2. p. 54.5.
[8] Torremocha F, Hadjadj S, Carre F, Rosenberg T, Herpin D, Marechaud R.
Prediction of major coronary events by coronary risk profile and silent myo-
cardial ischemia: Prospective follow up study of primary prevention in 72
diabetic patients. Diabetes Metab 2001;27:49–57.
[9] Lamarche B, Moorjani S, Cantin B, Dagenais GR, Lupien PJ, Despres JP. Associa-
tions of HDL
2
and HDL
3
subfractions with ischemic heart disease in men:
prospective results from the Quebec Cardiovascular Study. Arterioscler
Thromb Vasc Biol 1997;17(6):1098–105.
[10] Legato MJ. Dyslipidem ia, gender, and the role of high-density lip oprotein
cholesterol: implications for therapy. Am J Cardiol 2000;86(12A):
15L–18L.
R.M. Parikh et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 4 (2010) 10–12
12
... Our finding showed that combined dyslipidemia (high LDL-C and low HDL-C) was the second most common in the study population. Parik et al. found that the prevalence of combined dyslipidemia of high LDL and low HDL was 22.7%, while that of high TG and high LDL-C was 12%, and that of a combination of high TG and low HDL-C was 10.3% [16]. Among isolated dyslipidemias, high LDL-C was seen in 15.6%, low HDL-C in 11.6%, and high TG in 4% of the Western Indian population [16]. ...
... Parik et al. found that the prevalence of combined dyslipidemia of high LDL and low HDL was 22.7%, while that of high TG and high LDL-C was 12%, and that of a combination of high TG and low HDL-C was 10.3% [16]. Among isolated dyslipidemias, high LDL-C was seen in 15.6%, low HDL-C in 11.6%, and high TG in 4% of the Western Indian population [16]. Another American study showed that the prevalence of combined high LDL-C and low HDL-C was 10%, while that of elevated LDL-C and TG was 12%, and that of elevated TG and low HDL-C was 16%. ...
The Association of Dyslipidemia and Atherogenic Indices With Glycemic Control in Diabetic Dyslipidemia Patients: A Real-World Landscape
Article
Full-text available
  • Sep 2023
Background: Dyslipidemia is an important comorbid factor of type 2 diabetes mellitus (T2DM) that increases the risk of cardiovascular diseases. This study aimed to assess the pattern of dyslipidemia and atherogenic indices and determine its relation with glycemic control. Methods:A cross-sectional study enrolled 382 patients with diabetic dyslipidemia. The socio-demographics data, clinical features, and laboratory parameters were collected. The baseline lipid parameters such as total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and glycated hemoglobin (HbA1C) were measured. Atherogenic indices such as TC/HDL-C ratio, TG/HDL-C ratio, LDL-C/HDL-C ratio, non-HDL-C/HDL-C and atherogenic index of plasma (AIP) [log10 (TG/HDL-C)] were calculated. T2DM patients were classified into three groups based on the degree of glycemic control: Good glycemic control (HbA1C<7%), fair control (HbA1C 7-8%), and poor control (HbA1C>8%). Results:The population’s mean age was 48.60±6.15 years, with 145 (38%) males. We found mixed dyslipidemia as the most prevalent (36.1%) form of dyslipidemia in our patients. The most common pattern in atherogenic indices was AIP (94.2%). HbA1c was positively correlated with duration of diabetes (r=0.253, p<0.001). In multivariate logistic regression analysis, duration of diabetes (>10 years) was significantly associated with poor glycemic control with an odds ratio (OR) of 2.31(95% CI; 1.25-4.24, p=0.007). Conclusion:The present study indicated that neither the pattern of dyslipidemia nor the atherogenic indices were markers of poor glycemic control among South Indian patients attending our tertiary care institute. However, duration of diabetes was significantly associated with poor glycemic control.
View
... where it was 89%. [8] The most common pattern of dyslipidemia in our study was combined dyslipidemia of increased LDL-C and decreased HDL-C (46.1%) which is comparable with the study done by Parikh et al. [9] Increased TG and decreased HDL-C were found in 28.3% of the population in this study. In our study, we found hypertriglyceridemia in 48.6%, LDL hyperlipoproteinemia in 69.5%, and decreased HDL-C dyslipidemia in 60.0% of type 2 diabetic patients, whereas in a study by Udawat et al., it was 22%, 76%, and 58%, respectively. ...
... [8] A study done by Parikh et al. showed that the most common pattern of dyslipidemia is high-LDL-C and low-HDL-C among both males and females which is consistent with our findings. [9] We found that good glycemic control has a modest effect on lipid parameters in type 2 diabetics. Literature also confirmed that TG and HDL-C levels often may remain abnormal despite improved glycemic treatment [10] and in population studies, dyslipidemia was not related to levels of glycemic control. ...
View
... Supporting this observation, Gomez Rosso et al. [2017] have demonstrated that inadequate glycemic control can affect the composition and function of HDL (16) . In a study by Rakesh showed that the Prevalence of dyslipidemia among diabetic patients at baseline was 85.5% among males and 97.8% among females (17) , but our present study revealed the dyslipidemia is 80.9% of male diabetic patients and 88.6% of female diabetic patients. Our study suggests that HbA1c can serve as a marker for dyslipidemia in diabetic patients, aiding in the prediction of cardiovascular disease [CVD] risk. ...
View
... Patients also had larger waist circumferences and WHR, despite no significant difference in BMI, which suggests WHR is a better predictor of T2DM than BMI [42]. Patients had higher levels of TG, LDL, and VLDL and lower levels of HDL, which is characteristic of dyslipidaemia commonly found in diabetics due to the influence of insulin resistance on lipid metabolism [43][44][45]. ...
Genetic Risk Scores for the Determination of Type 2 Diabetes Mellitus (T2DM) in North India
Article
Full-text available
Background: Globally, type 2 diabetes mellitus (T2DM) is one of the fastest-growing noncommunicable multifactorial and polygenic diseases, which leads to many health complications and significant morbidity and mortality. South Asians have a high genetic predisposition to T2DM, with India being home to one in six diabetics. This study investigates the association of selected genetic polymorphisms with T2DM risk and develops a polygenic risk score (PRS). Methods: A case-control study recruited fully consented participants from a population of Jat Sikhs in north India. DNA samples were genotyped for a range of polymorphisms and odds ratios were calculated under several genetic association models. Receiver operating characteristic (ROC) curves were produced for combinations of the PRS and clinical parameters. Results: The GSTT1(rs17856199), GSTM1(rs366631), GSTP1(rs1695), KCNQ1(rs2237892), ACE(rs4646994), and TCF7L2(rs12255372; rs7903146; rs7901695) polymorphisms were associated with increased T2DM risk (p ≤ 0.05). No association was observed with IGF2BP2(rs4402960) or PPARG2(rs1801282). The weighted PRS was found to be significantly higher in patients (mean = 15.4, SD = 3.24) than controls (mean = 11.9, SD = 3.06), and t(454) = -12.2 (p < 0.001). The ROC curve analysis found the weighted PRS in combination with clinical variables to be the most effective predictor of T2DM (area under the curve = 0.844, 95%CI = 0.0.808-0.879). Conclusions: Several polymorphisms were associated with T2DM risk. PRS based on even a limited number of loci improves the prediction of the disease. This may provide a useful method for determining T2DM susceptibility for clinical and public health applications.
View
... The prevalence of dyslipidemia in patients with diabetes is very high and was 85.5% among males and 97.8% among females at baseline in one Indian study. 40 In another study, subjects belonging to low socio-economic strata and residing in the urban slums also showed substantial prevalence of hypercholesterolemia (27%) and hypertriglyceridemia (12-17%). 41 In a population-based study, 47.3% of those without diabetes with a mean BMI of 25.83 ± 4.62 (obese as per South-Asian cut-off) had dyslipidemia, 20.6% had hypercholesterolemia, 19.6% had hypertriglyceridemia, and 17.5% had low HDL-C levels. ...
Management of Diabetic Dyslipidemia in Indians: Expert Consensus Statement from the Lipid Association of India
Article
  • Nov 2022
  • J CLIN LIPIDOL
In 2021 an estimated 74 million individuals had diabetes in India, almost all type 2 diabetes. More than half of patients with diabetes are estimated to be undiagnosed and more 90% have dyslipidemia that is associated with accelerated development of atherosclerotic cardiovascular disease (ASCVD). Patients of Indian descent with diabetes have multiple features that distinguish them from patients with diabetes in Western populations. These include characteristics such as earlier age of onset, higher frequency of features of the metabolic syndrome, more prevalent risk factors for ASCVD, and more aggressive course of ASCVD complications. In light of the unique features of diabetes and diabetic dyslipidemia in individuals of Indian descent, the Lipid Association of India developed this expert consensus statement to provide guidance for management of diabetic dyslipidemia in this very high risk population. The recommendations contained herein are the outgrowth of a series of 165 webinars conducted by the Lipid Association of India across the country from May 2020 to July 2021, involving 155 experts in endocrinology and cardiology and an additional 2880 physicians.
View
... The dyslipidemia rate in India was 85.5%-97.8% [11], and in Spain it was 81.2% [12], which is similar to this finding. While a study in North and East China showed dyslipidemia rate of 67.1% [6], which is lower than the dyslipidemia rate in this survey. ...
Prevalence of dyslipidemia, treatment rate and its control among patients with type 2 diabetes mellitus in Northwest China: a cross-sectional study
Article
Full-text available
  • Aug 2022
  • LIPIDS HEALTH DIS
Background The prevalence of cardiovascular disease (CVD) is high in China, especially in Northwest China, and dyslipidemia in diabetes is a major factor at risk for CVD. The dyslipidemia prevalence, treatment and control among type 2 diabetes mellitus (T2DM) patients in Northwest China were investigated. Methods In the cross-sectional retrospective research, 1386 medical records of T2DM patients were collected from the Endocrine Department of Tangdu Hospital. And patients’ age, sex, diabetes duration, glycated hemoglobin (HbA1c), complications, lipid levels, and drug use were recorded. The patient characteristics, lipid level and lipid-lowering therapy were analyzed. Results In this study, the dyslipidemia prevalence among T2DM patients was 87.7%, the treatment rate was 68.0%. The overall control rate of low-density lipoprotein cholesterol (LDL-C) was 43.1%, and control rates reached 52.7% for high-risk subjects and 36.1% for very high-risk subjects. The overall control rate of non-high-density lipoprotein cholesterol (non-HDL-C) was 19.8%. HbA1c (%) ≥ 7 was indicated as a major factor predicting failure of LDL-C and non-HDL-C control [odds ratio (OR) 1.521; 2.206, 95% confidence interval (CI) 1.154–2.005; 1.583–3.076)]. Conclusion Among patients with T2DM, it is high prevalence of dyslipidemia and low rate of treatment and control, and higher HbA1c level is the main factor for poor lipid control. It calls for more efforts to promote early screening, prevention and treatment of dyslipidemia for patients, thereby reducing the risk of CVD.
View
... The current prevalence of dyslipidemia is also comparable with other studies, which reported that 61% [42] to 88% [37,43,44] of Nepalese patients with T2DM had dyslipidemia. Similarly, the prevalence of dyslipidemia in patients with T2DM in India ranged from 34.7% [31] to more than 85% [45]. The high prevalence of dyslipidemia in the current study is likely due to poor diet and obesity, and it alleged that there could be no regular lipid measurements and monitoring performed in a sub-urban setting. ...
Poor glycemic control, cardiovascular disease risk factors and their clustering among patients with type 2 diabetes mellitus: A cross-sectional study from Nepal
Article
Full-text available
Background: Cardiovascular disease (CVD) is the most common complication of diabetes mellitus (DM). To prevent morbidity and mortality among patients with type 2 diabetes mellitus (T2DM), optimization of glycemic status and minimizing CVD risk factors is essential. As Nepal has limited data on these CVD risk parameters, we assessed the prevalence of poor glycemic control, CVD risk factors, and their clustering among patients with T2DM. Methods: Using a cross-sectional study design, we collected data of 366 patients with T2DM. We applied a multistage cluster sampling technique and used the WHO STEPS tools. Binary logistic and Poisson regression was applied to calculate odds and prevalence ratio of clustering of risk factors, considering P< 0.05 statistically significant. Results: The mean age of participants was 54.5±10.7 years and 208 (57%) were male. The prevalence of poor glycemic control was 66.4% (95% C.I: 61.5-71.2). The prevalence of smoking, alcohol users, inadequate fruit and vegetables intake and physical inactivity were 18% (95% C.I:14 to 21.9), 14.8% (95% C.I:11.1 to 18.4), 98.1% (95% C.I: 96.7-99.4), and 9.8% (95% C.I:6.7-12.8), respectively. Overall, 47.3% (95% C.I: 42.1-52.4) were overweight and obese, 59% (95% C.I: 52.9-63) were hypertensive, and 68% (95% C.I: 63.2-72.7) had dyslipidemia. Clustering of two, three, four, five and more than five risk factors was 12.6%, 30%, 30%,19%, and 8.7%, respectively. Four or more risk factors clustering was significantly associated with gender, age, level of education, T2DM duration, and use of medication. Risk factors clustering was significantly higher among males and users of anti-diabetic medications with prevalence ratio of 1.14 (95% C.I:1.05-1.23) and 1.09 (95% C.I: 1.09-1.18)], respectively. Conclusions: The majority of the patients with T2DM had poor glycemic control and CVD risk factors. Policies and programs focused on the prevention and better management of T2DM and CVD risk factors should be implemented to reduce mortality in Nepal.
View
... Recent evidence suggests that low HDL cholesterol is an independent factor not only for cardiovascular disease but also for the development of diabetes itself [19] . These changes, and the presence of small dense LDL particles, probably contribute to accelerated atherosclerosis even before diabetes is formally diagnosed [20] . In type 1 diabetes, hypertriglyceridemia may occur, but HDL cholesterol levels are often normal or even high unless glycemic control is poor or nephropathy is present [21] . ...
evaluate the efficacy and safety profile of Rosuvastatin, Simvastatin and Atorvastatin in newly diagnosed type 2 diabetic patients with dyslipidaemia
Article
Full-text available
  • Jun 2022
Dyslipidemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. The lipid changes associated with diabetes mellitus are attributed to increased free fatty acid flux secondary to insulin resistance. This is prospective, comparative, open label, randomized and parallel group. The subjects enrolled for this study were selected from the Out-Patient Department of Medicine collaboration with Department of Pharmacology, Tertiary care teaching hospital over a period of month. Newly diagnosed 90 cases of patients of Type II Diabetes Mellitus well controlled on oral hypoglycemic drugs were randomly divided into 3 groups of 30 each. Group A was received Rosuvastain 10 mg O.D for 3 months, Group B: Simvastatin 10 mg O.D and Group C was received Atrovastatin 10 mg O.D. In Group ‘A’ the mean difference of Total Cholesterol between baseline versus after 6 months was 82.37 mg/dl, 64.92 mg/dl and 52.23 mg/dl in Group B and Group C respectively. The mean difference of Triglycerides between baseline versus after 6 months was 65.04 mg/dl in Group A, 39.99 mg/dl in Group B and 37.04 mg/dl in Group C.
View
View
Prevalence of different patterns of dyslipidemia in patients with type 2 diabetes in an Iranian population
Article
Full-text available
  • Oct 2022
Background: Diabetic dyslipidemia is a complex multidimensional abnormality. However, earlier studies did not focus on the prevalence of various patterns of dyslipidemia. We categorized dyslipidemia into three groups. Single dyslipidemia (7 patterns) and mixed dyslipidemia consisted of dual (16 patterns) and triple (4 patterns) combinations of different patterns of single dyslipidemia. Methods: This cross-sectional study included 2097 patients with type 2 diabetes (T2D) between 2014 and 2021. We measured blood lipid profile parameters and calculated the atherogenic index of plasma (AIP) using log (TG/HDL-C). We analyzed dyslipidemia as a categorical variable and expressed results as numbers and percentages. We used Chi-square or Fisher exact tests to compare categorical variables. Results: A total of 97.81% of patients had at least one lipid abnormality. High AIP (88.0%) was the most common pattern, followed by LDL-C ≥ 70mg/dl (80.1%), and low HDL-C (58.0%). 73.87% of patients had mixed dyslipidemia. The dual combination of high AIP and LDL-C ≥ 70mg/dl was the most common pattern of mixed dyslipidemia (71.1%). Additionally, 24.7% of patients had triple combination dyslipidemia. All dyslipidemia patterns were more common among women than men, except for high AIP. In patients with T2D and coronary artery disease (CAD) history, high AIP was the most prevalent pattern of dyslipidemia (87.5%), followed by LDL ≥ 70mg/dl (68.6%). Also, the dual combination of high AIP and LDL ≥ 70mg/dl was the most common pattern of mixed dyslipidemia in patients with T2D and CAD history (60.67%). Conclusion: This study showed that single and mixed (dual and triple combination) dyslipidemia is common among patients with T2D. High AIP and LDL-C ≥ 70mg/dl were the most common patterns, either single or combined, in patients with or without CAD.
View
Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23)
Article
Full-text available
  • Mar 1998
To evaluate baseline risk factors for coronary artery disease in patients with type 2 diabetes mellitus. A stepwise selection procedure, adjusting for age and sex, was used in 2693 subjects with complete data to determine which risk factors for coronary artery disease should be included in a Cox proportional hazards model. 3055 white patients (mean age 52) with recently diagnosed type 2 diabetes mellitus and without evidence of disease related to atheroma. Median duration of follow up was 7.9 years. 335 patients developed coronary artery disease within 10 years. Angina with confirmatory abnormal electrocardiogram; non-fatal and fatal myocardial infarction. Coronary artery disease was significantly associated with increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, and increased triglyceride concentration, haemoglobin A1c, systolic blood pressure, fasting plasma glucose concentration, and a history of smoking. The estimated hazard ratios for the upper third relative to the lower third were 2.26 (95% confidence interval 1.70 to 3.00) for low density lipoprotein cholesterol, 0.55 (0.41 to 0.73) for high density lipoprotein cholesterol, 1.52 (1.15 to 2.01) for haemoglobin A1c, and 1.82 (1.34 to 2.47) for systolic blood pressure. The estimated hazard ratio for smokers was 1.41 (1.06 to 1.88). A quintet of potentially modifiable risk factors for coronary artery disease exists in patients with type 2 diabetes mellitus. These risk factors are increased concentrations of low density lipoprotein cholesterol, decreased concentrations of high density lipoprotein cholesterol, raised blood pressure, hyperglycaemia, and smoking.
View
Gemfibrozil for the Secondary Prevention of Coronary Heart Disease in Men with Low Levels of High-Density Lipoprotein Cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group
Article
Full-text available
  • Sep 1999
Although it is generally accepted that lowering elevated serum levels of low-density lipoprotein (LDL) cholesterol in patients with coronary heart disease is beneficial, there are few data to guide decisions about therapy for patients whose primary lipid abnormality is a low level of high-density lipoprotein (HDL) cholesterol. We conducted a double-blind trial comparing gemfibrozil (1200 mg per day) with placebo in 2531 men with coronary heart disease, an HDL cholesterol level of 40 mg per deciliter (1.0 mmol per liter) or less, and an LDL cholesterol level of 140 mg per deciliter (3.6 mmol per liter) or less. The primary study outcome was nonfatal myocardial infarction or death from coronary causes. The median follow-up was 5.1 years. At one year, the mean HDL cholesterol level was 6 percent higher, the mean triglyceride level was 31 percent lower, and the mean total cholesterol level was 4 percent lower in the gemfibrozil group than in the placebo group. LDL cholesterol levels did not differ significantly between the groups. A primary event occurred in 275 of the 1267 patients assigned to placebo (21.7 percent) and in 219 of the 1264 patients assigned to gemfibrozil (17.3 percent). The overall reduction in the risk of an event was 4.4 percentage points, and the reduction in relative risk was 22 percent (95 percent confidence interval, 7 to 35 percent; P=0.006). We observed a 24 percent reduction in the combined outcome of death from coronary heart disease, nonfatal myocardial infarction, and stroke (P< 0.001). There were no significant differences in the rates of coronary revascularization, hospitalization for unstable angina, death from any cause, and cancer. Gemfibrozil therapy resulted in a significant reduction in the risk of major cardiovascular events in patients with coronary disease whose primary lipid abnormality was a low HDL cholesterol level. The findings suggest that the rate of coronary events is reduced by raising HDL cholesterol levels and lowering levels of triglycerides without lowering LDL cholesterol levels.
View
Atherogenesis in diabetes
Article
  • Jan 1992
  • Arterioscler Thromb
View
Diabetes and Decline in Heart Disease Mortality in US Adults
Article
  • Apr 1999
Context Mortality from coronary heart disease has declined substantially in the United States during the past 30 years. However, it is unknown whether patients with diabetes have also experienced a decline in heart disease mortality. Objective To compare adults with diabetes with those without diabetes for time trends in mortality from all causes, heart disease, and ischemic heart disease. Design, Setting, and Participants Representative cohorts of subjects with and without diabetes were derived from the First National Health and Nutrition Examination Survey (NHANES I) conducted between 1971 and 1975 (n=9639) and the NHANES I Epidemiologic Follow-up Survey conducted between 1982 and 1984 (n=8463). The cohorts were followed up prospectively for mortality for an average of 8 to 9 years. Main Outcome Measure Changes in mortality rates per 1000 person-years for all causes, heart disease, and ischemic heart disease for the 1982-1984 cohort compared with the 1971-1975 cohort. Results For the 2 periods, nondiabetic men experienced a 36.4% decline in age-adjusted heart disease mortality compared with a 13.1% decline for diabetic men. Age-adjusted heart disease mortality declined 27% in nondiabetic women but increased 23% in diabetic women. These patterns were also found for all-cause mortality and ischemic heart disease mortality. Conclusions The decline in heart disease mortality in the general US population has been attributed to reduction in cardiovascular risk factors and improvement in treatment of heart disease. The smaller declines in mortality for diabetic subjects in the present study indicate that these changes may have been less effective for people with diabetes, particularly women.
View
View
View
Associations of HDL2 and HDL3 Subfractions With Ischemic Heart Disease in Men: Prospective Results From the Quebec Cardiovascular Study
Article
  • Jul 1997
Individuals with elevated plasma concentrations of HDL cholesterol are at lower risk for ischemic heart disease (IHD). Whether the cardioprotective effects of HDL can be attributed to one or both HDL subfractions (HDL2 and HDL3) remains, however, controversial. The relationship of HDL subfractions to the incidence of IHD was investigated in a sample of 1169 French-Canadian men younger than 60 years and living in the Quebec City suburbs. Between 1980 to 1981 and 1990, 83 of the 944 men with complete follow-up in 1990 (80.8%) had a first IHD. Men who developed IHD had lower HDL, HDL2, and HDL3 cholesterol concentrations at baseline than men who remained free from IHD. Adjusted relative risk (RR) of IHD was calculated among quartiles of HDL cholesterol and HDL subfractions with the use of Cox survival models. Men in the fourth quartile of HDL2 (RR = 0.21; 95% confidence interval [CI], 0.08 to 0.56) and HDL3 cholesterol distributions (RR = 0.37; 95% CI, 0.15 to 0.94) were at lower risk for IHD than men in the first quartile. Despite the fact that the respective contributions of HDL2 and HDL3 to IHD risk were of the same magnitude in a multivariate model that included both subfractions, the contribution of the HDL2 subfraction was statistically significant (standardized RR = 0.84; 95% CI, 0.74 to 0.95), whereas it did not reach significance for HDL3 (standardized RR = 0.87; 95% CI, 0.69 to 1.11). Neither the linear combination of HDL2 and HDL3 nor their ratio provided further information on the risk of IHD compared with HDL cholesterol alone or with the ratio of total to HDL cholesterol. From a statistical standpoint, the present data suggest that the HDL2 subfraction may be more closely related to the development of IHD than the HDL3 subfraction. However, the qualitative difference in the relative predictive value of each subfraction was trivial, since it only corresponded to a modest quantitative difference. Thus, the possibility that a significant proportion of the cardioprotective effect of elevated HDL cholesterol levels may be mediated by the HDL3 subfraction still cannot be excluded. Finally, from a clinical point of view and within the limits of resolution provided by these data, the measurement of HDL subfractions does not appear to provide any additional information on the risk of IHD than HDL cholesterol alone or the ratio of total to HDL cholesterol.
View
Diabetes and decline in heart disease mortality in US adults
Article
  • May 1999
Mortality from coronary heart disease has declined substantially in the United States during the past 30 years. However, it is unknown whether patients with diabetes have also experienced a decline in heart disease mortality. To compare adults with diabetes with those without diabetes for time trends in mortality from all causes, heart disease, and ischemic heart disease. Representative cohorts of subjects with and without diabetes were derived from the First National Health and Nutrition Examination Survey (NHANES I) conducted between 1971 and 1975 (n = 9639) and the NHANES I Epidemiologic Follow-up Survey conducted between 1982 and 1984 (n = 8463). The cohorts were followed up prospectively for mortality for an average of 8 to 9 years. Changes in mortality rates per 1000 person-years for all causes, heart disease, and ischemic heart disease for the 1982-1984 cohort compared with the 1971-1975 cohort. For the 2 periods, nondiabetic men experienced a 36.4% decline in age-adjusted heart disease mortality compared with a 13.1% decline for diabetic men. Age-adjusted heart disease mortality declined 27% in nondiabetic women but increased 23% in diabetic women. These patterns were also found for all-cause mortality and ischemic heart disease mortality. The decline in heart disease mortality in the general US population has been attributed to reduction in cardiovascular risk factors and improvement in treatment of heart disease. The smaller declines in mortality for diabetic subjects in the present study indicate that these changes may have been less effective for people with diabetes, particularly women.
View
Prediction of major coronary events by coronary risk profile and silent myocardial ischaemia: Prospective follow-up study of primary prevention in 72 diabetic
Article
  • Mar 2001
  • DIABETES METAB
Unlabelled: The aim of this study was to examine the predictive value of coronary risk profile (CRP) for major coronary events in patients screened for silent myocardial ischemia (SMI). We studied 72 diabetic patients, aged 41 to 65 years, recruited consecutively at the Poitiers diabetes clinic. All patients had at least one cardiovascular risk factor associated with diabetes mellitus (type 1 diabetes duration > or =15 years, dyslipidaemia, smoking, hypertension, micro/macro-albuminuria). A structured questionnaire, physical examination and resting electrocardiogram provided no evidence of coronary heart disease. SMI was defined as positive exercise electrocardiogram and/or dipyridamole thallium myocardial scintigraphy. CRP was estimated using the Framingham equation adapted to the French population. We defined a high CRP value as annual CRP > or =1.5%. Major coronary events (MCE) were defined as myocardial infarction, ischaemic heart failure, unstable angina or sudden death. Twenty-one patients with type 1, and 51 with type 2 diabetes were followed up for 39+/-12 months: 30 women and 42 men, aged 55+/-7 years with diabetes duration of 16 +/- 11 years (mean +/- SD). SMI was detected in 8 patients. Major coronary events occurred in 8 patients, 2 of whom had SMI. High CRP was found in 18 patients, 3 of whom had MCE. CRP was significantly higher in those patients with a major coronary event (1.71 +/- 1.11 versus 1.03 +/- 0.56%; p=0.048), but not in those with SMI (1.19 +/- 0.72 vs 1.09 +/- 0.67%; p=0.654). In Kaplan-Meier survival analysis, a high CRP was associated with the risk of a major coronary event (log-rank=5.36; p=0.021), whereas SMI was not (log-rank=2.02; p=0.155). The cumulative incidence of MCE in those patients with high and low CRP was 8.08 (0.49-15.67) vs 2.15 (0.06-4.22) events per 100 patient year of follow-up, respectively. Conclusion: CRP had a good predictive value for major coronary events regardless the presence of SMI. Prevention should therefore be focused primarily on patients with high CRP, wether or not they have SMI.
View
Dyslipidemia, gender, and the role of high-density lipoprotein cholesterol: Implications for therapy
Article
  • Dec 2000
  • AM J CARDIOL
Cardiovascular disease, which kills more US women than all cancers combined, may pose an even greater risk for women than for men. For example, the risk factors, testing modalities, presenting symptoms and the therapeutic choices made for women with coronary artery disease are significantly different from those for men. Low levels of high-density lipoprotein cholesterol (HDL-C), <35 mg/dL in men and <45 mg/dL in women, is associated with a greater risk of coronary artery disease and more progression of angiographically demonstrated disease in women, while increasing HDL-C has a more cardioprotective effect in the female than in the male population. The total cholesterol-to-HDL-C ratio is also more predictive of coronary artery disease in women than in men. Because average HDL-C levels in women are approximately 10 mg/dL higher than in men, target HDL-C should be higher (>45 mg/dL) in women. This is not yet reflected in clinical guidelines. Diabetes is particularly hazardous in women, and low HDL-C levels constitute a disproportionate risk for coronary artery disease in diabetic women compared with diabetic men. Regrettably, although lipid-lowering drugs have been shown to be effective in women, they are more rarely prescribed for women than for men.
View