Oxidized LDL but not total LDL is associated with HbA1c in individuals without diabetes

Association between measured or calculated small dense low-density lipoprotein cholesterol and oxidized low-density lipoprotein in subjects with or without type 2 diabetes mellitus

BACKGROUND

Small dense low-density lipoprotein (sdLDL) possesses atherogenic potential and is predicted to be susceptible to atherogenic modifications, which further increases its atherogenicity. However, studies on the association between measured or estimated sdLDL cholesterol (sdLDL-C) levels and atherogenic modification in diverse population groups are lacking.

METHODS

Surplus serum samples were collected from male subjects with type 2 diabetes mellitus (DM) under treatment (n = 300) and without DM (non-DM; n = 150). sdLDL and oxidized LDL (oxLDL) levels were measured using the Lipoprint LDL subfractions kit (Quantimetrix Corporation) and the Mercodia oxidized LDL competitive enzyme-linked immunosorbent assay kit (Mercodia), respectively. The estimated sdLDL-Cs were calculated from two relevant equations. The effects of sdLDL-C on oxLDL were assessed using multiple linear regression (MLR) models.

RESULTS

The mean (±SD) of measured sdLDL-C and oxLDL concentrations were 11.8 ± 10.0 mg/dl and 53.4 ± 14.2 U/L in the non-DM group and 0.20 ± 0.81 mg/dl and 46.0 ± 15.3 U/L in the DM group, respectively. The effects of measured sdLDL-Cs were significant (p = 0.031), whereas those of estimated sdLDL-Cs were not (p = 0.060, p = 0.116) in the non-DM group in the MLR models. The effects of sdLDL-Cs in the DM group were not significant.

CONCLUSION

In the general population, high level of sdLDL-C appeared to be associated with high level of oxLDL. The equation for estimating sdLDL-C developed from a general population should be applied with caution to a special population, such as patients with DM on treatment.

Causal Association of Type 2 Diabetes Mellitus and Glycemic Traits With Cardiovascular Diseases and Lipid Traits: A Mendelian Randomization Study

Objective

We aimed to evaluate the causal effect of type 2 diabetes mellitus (T2DM) and glycemic traits on the risk of a wide range of cardiovascular diseases (CVDs) and lipid traits using Mendelian randomization (MR).

Methods

Genetic variants associated with T2DM, fasting glucose, fasting insulin, and hemoglobin A1c were selected as instrumental variables to perform both univariable and multivariable MR analyses.

Results

In univariable MR, genetically predicted T2DM was associated with higher odds of peripheral artery disease (pooled odds ratio (OR) =1.207, 95% CI: 1.162-1.254), myocardial infarction (OR =1.132, 95% CI: 1.104-1.160), ischemic heart disease (OR =1.129, 95% CI: 1.105-1.154), heart failure (OR =1.050, 95% CI: 1.029-1.072), stroke (OR =1.087, 95% CI: 1.068-1.107), ischemic stroke (OR =1.080, 95% CI: 1.059-1.102), essential hypertension (OR =1.013, 95% CI: 1.010-1.015), coronary atherosclerosis (OR =1.005, 95% CI: 1.004-1.007), and major coronary heart disease event (OR =1.003, 95% CI: 1.002-1.004). Additionally, T2DM was causally related to lower levels of high-density lipoprotein cholesterol (OR =0.965, 95% CI: 0.958-0.973) and apolipoprotein A (OR =0.982, 95% CI: 0.977-0.987) but a higher level of triglycerides (OR =1.060, 95% CI: 1.036-1.084). Moreover, causal effect of glycemic traits on CVDs and lipid traits were also observed. Finally, most results of univariable MR were supported by multivariable MR.

Conclusion

We provided evidence for the causal effects of T2DM and glycemic traits on the risk of CVDs and dyslipidemia. Further investigations to elucidate the underlying mechanisms are warranted.

Perbedaan Hemoglobin Terglikosilasi (Hba1c) terhadap Profil Lipid Pasien Rumah Sakit Islam Surabaya

ABSTRAK Latar Belakang : Diabetes melitus merupakan penyakit metabolik dengan karakteristik hiperglikemia sebagai akibat kelainan sekresi insulin maupun kerja insulin. Diabetes sebagai salah satu penyebab dislipidemia sekunder, sehingga pengelolaan glukosa darah merupakan pencegahan primer timbulnya komplikasi penyakit kardiovaskular. Hasil Riskesdas tahun 2018, prevalensi diabetes melitus yang didiagnosis dokter pada penduduk di semua umur sebesar 3,4% di Kota Surabaya.Tujuan : Penelitian ini untuk mengetahui perbedaan profil lipid pada level HbA1C normal, prediabetes dan diabetes melitus.Metode : Penelitian cross sectional, teknik pengambilan sampel dengan simple random sampling dari data rekam medis pasien rawat jalan di Rumah Sakit Islam Surabaya  dari 1 Januari tahun 2018 sampai dengan 31 Desember 2019 berusia 35-80 tahun dan mendapat pemeriksaan HbA1c, kolesterol, trigliserida dan LDL-kolesterol pada waktu yang sama dan terdokumentasi lengkap pertama sekali sehingga diperoleh besar sampel 73 data pasien. Uji Anova one way digunakan untuk mengetahui perbedaan rata-rata kolesterol, trigliserida dan LDL-kolesterol berdasarkan HbA1C.Hasil : Hasil penelitian menunjukkantidakada perbedaan yang signifikan rata-rata kolesterol, dan LDL-kolesterol dengan tingkatan HbA1C (p>0,05), ada perbedaan yang signifikan rata-rata trigliserid dengan HbA1C normal, prediabetes, dan diabetes (p=0,01). Hasil multiple comparison dengan metode Tukey HSD menunjukkan perbedaan signifikan rata-rata trigliserid  pada HbA1C normal dengan diabetes (p=0,039) dan prediabetes dengan diabetes (p=0,044).Kesimpulan :Perbedaan rata-rata trigliserida signifikanpada HbA1Ckategorinormal dan prediabetes dengan diabetes, pentingnya mengendalikanglukosa darah untuk mencegahkomplikasi kardiovaskuler pada penderita diabetes melitus yang dapat dilakukan melalui pemantauan mandiri glukosa darah, pola hidup sehat, aktivitas fisik secara teratur, terapi nutrisi medis sesuai kebutuhan, menurunkan berat badan bagi yang mengalami obesitas, tidak merokokdan intervensi obat anti hiperglikemia jika dibutuhkan.Kata Kunci : diabetes, HbA1C, kolesterol, trigliserid, LDL-kolesterol. ABSTRACT  Background :Diabetes melitus is a metabolic disease characterized by hyperglicemia as a result of abnormal insulin secretion and insulin action. Diabetes is a cause of secondary dislipidemia, so that diabetes melitus monitoring is a primary deterrent to cardiovascular complication. Riskesdas 2018 said that the prevalence of doctors' diagnosed diabetes in the population at all age 3.4% in Surabaya.Objective : This study is to find out the difference in lipid profiles on normal HbA1Clevels, pre-diabetes and diabetes mellitusMethod: Cross-sectional study, the sampling technique used was simple random sampling fromoutpatient medical recordsthe Surabaya Islamic hospital's from 1st of January 2018 to 31st December 2019 aged 35-80 years and checked for HbA1C, cholesterol, triglyceride and LDL-cholesterol at the same and firsttime documented. Sample sizes of 73 data analized with One Way Anova test was used to identify differences in mean cholesterol, triglyceride and LDL-cholesterol based Hba1C.Results :The results showed that there was no significant difference mean cholesterol and mean LDL-cholesterol with HbA1C levels (p> 0.05), there were significant differences mean the triglyceride with normal HbA1C levels, pre-diabetes, and diabetes (p= 0.01). Multiple comparason results using Tukey HSD methods showed that there was significant differences mean the triglycerid on normal HbA1C levels with diabetes (p= 0.039) and the mean triglyceride ebetween hba1c prediabetesand diabetes (p= 0.044).Conclusions: The mean difference trigliseride signifnificant in normal HbA1C levels and pre-diabetes with diabetes.The importantce of controlling blood glucose to prevent cardiovasculer complication in people with diebetes mellitus can be done through education on independent monitoring of blood glucose, healthy lifestyle, reguler physical activity, medical nutrition therapy according to the needs, lost weight for those who are obese, do not smoke and  anti-hyperglicemia drug intervention if needed.

Beyond LDL-c: The importance of serum oxidized LDL in predicting risk for type 2 diabetes in the middle-aged Asian Indians

AIMS

Oxidized low-density lipoprotein (OxLDL) as the residual lipid plays a crucial role in cardiovascular complications and type 2 diabetes. This study aimed to evaluate the relationship of OxLDL with the conventional risk markers and to find the association of OxLDL with the risk of development of type 2 diabetes in middle-aged (30-50 years) Asian Indians.

MATERIALS AND METHODS

A total of 78 type 2 diabetes patients and 78 age-matched controls were recruited. The serum OxLDL concentration was assessed by enzyme-linked immunosorbent assay (ELISA). Other anthropometric and biochemical measures were also carried out. Multiple logistic regression was used to determine the association of OxLDL and OxLDL to non-oxidized lipoproteins with the occurrence of type 2 diabetes.

RESULTS

OxLDL was significantly higher in type 2 diabetes cases than controls (p < 0.001) even though there was no significant difference in LDL cholesterol (LDL-c) between type 2 diabetes patients and controls. OxLDL correlated significantly with fasting plasma glucose (FPG) and insulin resistance (HOMA-IR). OxLDL did not show any significant correlation with LDL-c. Multiple logistic regression showed a significant association of OxLDL, OxLDL/LDL-c and OxLDL/HDL-c with type 2 diabetes (p < 0.001). LDL-c showed no association with type 2 diabetes. ROC-AUC curve analyses showed OxLDL/HDL-c to have highest discriminatory power for type 2 diabetes (AUC: 0.710 with 95% CI: 0.629-0.791, p < 0.001).

CONCLUSION

Our findings highlight the possibly more attention has to be given to OxLDL for managing lipids and diabetes progression as well as reducing cardiac risk in middle-aged type 2 diabetes patients.

Oxidized Low-Density Lipoprotein to High-Density Lipoprotein Ratio Predicts Recurrent Stroke in Minor Stroke or Transient Ischemic Attack

Background and Purpose- Oxidized low-density lipoprotein (oxLDL) level is thought to be associated with recurrent stroke. We aimed to investigate the association between oxLDL to high-density lipoprotein (HDL) ratio and recurrent stroke in patients with minor stroke or transient ischemic attack. Methods- The study included 3019 patients with minor ischemic stroke or high-risk transient ischemic attack from the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events). Baseline oxLDL and HDL levels were measured. The primary outcome was any stroke within 90 days. The secondary outcomes included any stroke within 1 year and ischemic stroke and combined vascular events within 90 days and 1 year. The association between oxLDL/HDL and recurrent stroke was analyzed by using Cox proportional hazards. Results- Patients in the highest oxLDL/HDL quartile had a higher risk of recurrent stroke within 90 days (hazards ratio, 1.50; 95% CI, 1.08-2.08) compared with the lowest quartile after adjusting relevant confounding factors ( P=0.02). Similar results were found for secondary outcomes ( P<0.05 for all). There were no significant interaction between oxLDL/HDL and use of statins agents. Conclusions- Higher serum oxLDL/HDL level in minor stroke or transient ischemic attack was associated with increased risk of recurrent stroke in 90 days and 1 year. OxLDL/HDL may act as a powerful indicator of recurrent stroke in patients with minor stroke or transient ischemic attack. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00979589.