[HDL‐C/apoA‐I]: A multivessel cardiometabolic risk marker in women with T2DM

Abstract

Aims: Although women have higher high-density lipoprotein cholesterol (HDL-C) than have men, their HDL particles are also prone to become small, dense, and dysfunctional in case of type 2 diabetes mellitus (T2DM). To assess the vascular risk related to HDLs of different sizes/densities without direct measurement, we adjusted HDL-C to its main apolipoprotein Results: An adverse cardiometabolic profile characterized QI and QII patients whose HDLs were denser and depleted in apoA-I, whereas QIII patients had HDLs with characteristics closer to those of controls. QIV patients had HDLs of supernormal size/composition and a more favourable phenotype in terms of fat distribution; insulin sensitivity (64% vs 41%), metabolic syndrome, and β-cell function (32% vs 23%); exogenous insulin (44 vs 89 U·d −1 ); and glycaemic control (glycated haemoglobin, 56 vs 61 mmol·mol −1 ), associated with lower prevalence of microvascular/macrovascular complications: all-cause microangiopathy 47% vs 61%; retinopathy 22% vs 34%; all-cause macroangiopathy 19% vs 31%; and coronary artery disease 6% vs 24% (P < .05). Conclusion:[HDL-C/apoA-I] can stratify T2DM women according to metabolic phenotype, macrovascular and coronary damage, β-cell function, microangiopathic risk, and retinopathy. This ratio is a versatile and readily available marker of cardiometabolic status and vascular complications in T2DM women.

Lipoprotein (a) as a predictor of diabetic retinopathy in patients with type 2 diabetes: A systematic review

“…The relationship between lipoprotein (a) and diabetic retinopathy was consistent with many of the previous studies in which Lp(a) was evaluated as a categorical or continuous variable. 7,8,11,[13][14][15][16][17][19][20][21][22][23][24][25] The included studies supported the relationship between higher serum Lp (a) and diabetic retinopathy. Moreover, the link between Lp(a) and DR appeared more apparent in research from 2017 onwards than in studies before 2017.…”

“…Firstly, there was considerable controversy among the included research. Study characteristics, 7,8,11,[13][14][15][16][17][18][19][20][21][22][23][24][25] like definitions of diabetic retinopathy, follow-up duration, type of study, study country, and other factors, might significantly contribute to this controversy. Specifically, organic dietary products and medications, including phytosterol, 38,39 flaxseed, 40 L-carnitine, 41 and various lipid-lowering medications [42][43][44] that were rarely reported in the included articles, may affect LP(a) level.…”

“…Of these, 31 were also eliminated. Finally, 17 observational studies, including four prospective cohort research, 7,11,13,14 eleven cross-sectional studies, 8,9,[15][16][17][18][19][20][21][22][23] and two nested case-control studies, 24,25 were included in the systematic review.…”

“…In 13 articles, Lp(a) was described as a risk factor for DR 7-9, 11, 14-16, 19, 21-25 ; in three studies, there was no significant association between the serum Lp(a) ranges and DR in patients with T2DM 17,18,20 ; while another study reported a significant association between Lp(a) and DR. 13 Potential confounding factors adjusted in the studies included age, smoking, sex, body mass index, HbA1c, HDL cholesterol, LDL cholesterol, Levels of Lp(a), usage of antidiabetic pills, and lipid-lowering therapies.…”

Discussion on the Effectiveness of Elevating HDL-C in Treating Cardiovascular Diseases of Patients with Type 2 Diabetes Mellitus

“…Therefore, apo A-I is closely related to HDL-C concentration. Proteomics research continues to expand apolipoprotein spectrum and other related protein components in HDL [4]. HDL lipids are mainly free or esterified fatty acids, phospholipids and different ceramides and sphingolipids [5].…”