Differences in traditional and non-traditional risk factors with special reference to nutritional factors in patients with coronary artery disease with or without diabetes mellitus

Abstract

Introduction:There is an increase in awareness about the role of nutritional factors in chronic non-communicable diseases. We therefore conducted this study with an aim to assess the relationship between nutritional factor (vitamin B12 and homocysteine [Hcy]) and its association with insulin resistance and inflammatory markers, and differences in traditional and non-traditional risk factors among diabetics and non-diabetics in known cases of coronary artery disease (CAD).Materials and Methods:Three hundred consecutive patients with known coronary disease on coronary angiography, who were >25 years old were included in this study. All cases were interviewed using a questionnaire. Blood samples were analyzed for insulin, vitamin B12, Hcy and inflammatory markers (highly sensitive C-reactive protein [hsCRP], interleukin-6 [IL-6], Tumor necrosis factor-alfa [TNF-α]). Insulin resistance was calculated with homeostasis model assessment of insulin resistance (HOMA-IR).Results:Mean age of the patients was 60.95 ± 12.3 years. Body mass index and waist hip ratio were comparable in both groups. Triglyceride, very low-density lipoprotein and HbA1C were significantly higher and high-density lipoprotein (HDL) was significantly lower in patients with diabetes. Patients with diabetes had significantly high levels of IL-6, hsCRP and TNF-α compared with non-diabetic patients. Insulin resistance was twofold higher in diabetic patients. Serum vitamin B12 levels were significantly lower and Hcy was significantly higher in the diabetic group compared with the non-diabetic patients. HbA1C, HOMA-IR and Hcy levels were positively correlated with inflammatory markers in the total study population and in the non-diabetic patients; but, in diabetic patients, HbA1C and Hcy showed this relation.Conclusions:Vitamin B12 deficiency is common in the diabetic population. Hcy levels were higher in diabetics compared with non-diabetics, and were related to glycemic level and insulin resistance in diabetic patients. Patients with diabetes had higher traditional risk factors than patients without diabetes in known patients with CAD. Glycemic status was associated with insulin resistance and inflammatory markers.

Association of metabolic syndrome with severity of coronary artery disease

“…Subjects with diabetes mellitus, HTN and dyslipidemia increased with severity of coronary artery disease. [ 12 17 18 19 20 21 22 23 24 ] Multi-vesssel disease is more common in diabetic patients than in the controls, with TVD being the most common. [ 17 18 ] Rana et al .…”

“…[ 12 17 18 19 20 21 22 23 24 ] Multi-vesssel disease is more common in diabetic patients than in the controls, with TVD being the most common. [ 17 18 ] Rana et al . [ 19 ] also reported more involvement of CAD in DM versus non-DM individuals [SVD (19 vs. 14%), DVD (9 vs. 7%), and TVD (9 vs. 5%) ( P < 0.0001 for all)].…”

Towards precision medicine: defining and characterizing adipose tissue dysfunction to identify early immunometabolic risk in symptom-free adults from the GEMM family study

“…The most relevant age-related chronic immunometabolic diseases (type 2 diabetes [T2D] and CVD) associated with increased mortality are slowly progressive, associated with traditional CVD risk factors [10] and with a symptom-free onset [5]. These pathologies are the leading cause of death around the world [11].…”

“…Although fasting and postprandial dysglycemia, lipid-lipoprotein abnormalities, excess of body fat, and elevated systolic/diastolic blood pressure [10] are wellestablished traditional cardiometabolic risk factors [12], there is growing evidence to suggest that a metabolic inflammatory state, termed metaflammation [13] and defined as low-grade, chronic subclinical inflammation [5] orchestrated by metabolic cells in response to excess nutrients and energy [14] may be the underlying mechanism that determines whether or not an individual would develop these CVRIMO and cardiovascular risk abnormalities [15]. They are primarily associated with IR and an unfavourable inflammatory state characterized by high circulating levels of high-sensitivity C-reactive protein (hs-CRP), alpha necrosis tumour factor (TNF-α), hyperfibrinogenemia [16] and interleukin 6 (IL-6) [17].…”

The prevalence and treatment of metformin associated Vitamin B12 deficiency in patients with type 2 Diabetes Mellitus in New Zealand

“…In the presence of true Vitamin B12 deficiency the risk of developing hyperhomocystemia has been documented in populations with type 2 diabetes and without subdivision of treatment with metformin (Mahalle, Garg, Kulkarni, & Naik, 2013). In these particular studies the drop in serum Vitamin B12 status was attributed to both the presence of a diabetes state and the high prevalence of Vitamin B12 deficiency in the national populations.…”