Dyslipidemia and Hyperglycemia Predict Coronary Heart Disease Events in Middle-Aged Patients With NIDDM

Abstract

Patients with NIDDM are at increased risk for coronary heart disease (CHD). However, information on the predictive value of cardiovascular risk factors and the degree of hyperglycemia with respect to the risk for CHD in diabetic patients is still limited. Therefore, we carried out a prospective study on risk factors for CHD, including a large number of NIDDM patients. At baseline, risk factor levels of CHD were determined in 1,059 NIDDM patients (581 men and 478 women), aged from 45 to 64 years. These patients were followed up to 7 years with respect to CHD events. Altogether, 158 NIDDM patients (97 men [16.7%] and 61 women [12.8%]) died of CHD and 256 NIDDM patients (156 men [26.8%] and 100 women [20.9%]) had a serious CHD event (death from CHD or nonfatal myocardial infarction). A previous history of myocardial infarction, low HDL cholesterol level (<1.0 mmol/l), high non-HDL cholesterol (> or =5.2 mmol/l), high total triglyceride level (>2.3 mmol/l), and high fasting plasma glucose (>13.4 mmol/l) were associated with a twofold increase in the risk of CHD mortality or morbidity, independently of other cardiovascular risk factors. High calculated LDL cholesterol level (> or =4.1 mmol/l) was significantly associated with all CHD events. The simultaneous presence of high fasting glucose (>13.4 mmol/l) with low HDL cholesterol, low HDL-to-total cholesterol ratio, or high total triglycerides further increased the risk for CHD events up to threefold. Our 7-year follow-up study provides evidence that dyslipidemia and poor glycemic control predict CHD mortality and morbidity in patients with NIDDM.

Efeito do exercício físico aeróbio sobre o perfil lipídico de pacientes idosas, portadoras de Diabetes Mellitus tipo 2, atendidas em Unidade Básica de Saúde, Maringá, Estado do Paraná.

“…8,18,37,38,39 Entretanto, em relação ao LDL-colesterol, os dados da literatura são menos conclusivos, mas a maioria dos pacientes diabéticos possui taxas elevadas de LDL-colesterol. De acordo com os resultados do Third National Health and Nutrition Examination Survey (NHANES III), 40 por exemplo, 84,6% dos pacientes com DM tipo 2 têm os níveis de LDL-colesterol acima do ótimo (100mg/dL).Neste estudo, também observamos valores médios de LDL-colesterol acima do recomendado (139,28 e 147,98 mg/dL) para os grupos Controle e Treinado, respectivamente.…”

Joint Distribution of Non-HDL and LDL Cholesterol and Coronary Heart Disease Risk Prediction Among Individuals With and Without Diabetes

“…The RR for the highest quartile of non-HDL cholesterol was significantly higher than that for LDL cholesterol: 2.34 (95% CI 1.26 -4.43) vs. 1.74 (0.99 -3.06). In a Finish cohort study (25), 1,059 middleaged men and women with type 2 diabetes were followed for 7 years, and it was found that higher levels of non-HDL cholesterol were independently associated with a twofold increase in the risk for CHD death or morbidity, although there was no direct comparison between LDL and non-HDL cholesterol for the predictive values of CHD. In the Strong Heart Study cohort (26) of 2,108 AmericanIndian men and women aged 45-74 years with diabetes, the hazard ratios for the highest tertile of non-HDL cholesterol were higher than those for LDL cholesterol among both diabetic men and women, although the CIs were overlapping.…”

Effect of age on the association of non-high-density-lipoprotein cholesterol and apolipoprotein B with cardiovascular mortality in a Mediterranean population with type 2 diabetes: the Casale Monferrato study

“…Since that time, a substantial number of reports have indicated that ApoB and non-HDL-cholesterol are better predictors than LDL-cholesterol in people with diabetes [16][17][18][19]. Few studies have been conducted, however, to compare non-HDL-cholesterol with ApoB [18,19]; the studies that have been reported were restricted to North America, and the results were mixed.…”