Measured versus calculated LDL-cholesterol in subjects with type 2 diabetes

An evaluation of inflammatory and endothelial dysfunction markers as determinants of peripheral arterial disease in those with diabetes mellitus

The most serious long-term effects of diabetes is peripheral artery disease (PAD) which increases the chance of developing diabetic foot ulcers, gangrene and even lower limb amputation. The clinical manifestations of PAD which are typically not revealed until symptoms like intermittent claudication, rest pain and ischemic gangrene develop, are not present in majority of diabetes mellitus patients with PAD due to diabetic peripheral neuropathy. Therefore, current study is aimed to evaluate the inflammatory and endothelial dysfunction markers with their correlation to biomarkers that can help for in-time diagnosis and efficient prognosis of developing diabetes-associated PAD. Enzyme-linked immunosorbent assay was used to evaluate the interlukin-6, interlukin-8, intercellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) in PAD with diabetes group, diabetic group and healthy individual group while biomarkers were measured by kit method. It was observed that serum IL-6, IL-8, ICAM and VCAM levels in type II diabetes mellitus (T2DM) with PAD patients were increased significantly (85.93, 597.08, 94.80 and 80.66) as compared to T2DM patients (59.52, 231.34, 56.88 and 50.19) and healthy individuals (4.81, 16.93, 5.55 and 5.16). The overall means for the parameters, IL-6, IL-8, ICAM, VCAM, urea, S/creatinine, CK-MB, AST, ALT, cholesterol, triglyceride, HDL, LDL, PT, aPTT, INR, HbA1C, and CRP within all groups were significantly (P < 0.05) different from each other. Therefore, it was concluded that the change in IL-6, IL-8, ICAM and VCAM can serve as an accurate diagnostic indicator and successful treatment.

The effect of Thyroid Autoimmunity on Dyslipidemia in patients with Euthyroid Hashimoto Thyroiditis

Background & Objective:

The relationship between thyroid disorders and dyslipidemia has now been clearly demonstrated, but the relationship between thyroid autoimmunity and dyslipidemia in euthyroid patients is still controversial. Our aim in this study was to determine whether there is a risk of dyslipidemia in our patients with euthyroid hashimoto thyroiditis.

Methods:

Fifty-five autoantibody positive hashimoto patients and 55 antibody negative control groups who came to Sakarya University Medicine Faculty Endocrinology Outpatient Clinics between January 2018 and November 2019 were included in our case control study. The groups were similar in terms of age, cardiovascular risk factors and BMI. Both groups were compared according to the lipid profile results.

Results:

All type of lipids; including LDL (p = 0.008), HDL (p = 0.041), triglyceride (p = 0.045) and total cholesterol (p = 0.002), were higher in the patient group, and these differences were statistically significant. Anti-TPO and Anti-TG antibody titers and lipid levels were evaluated by separate correlation analysis. There was a significant positive correlation between Anti-TPO and LDL (r = 0.331, p <0.001), triglyceride (r = 0.267, p = 0.005) and total cholesterol (r = 0.316, p = 0.001), however no significant correlation was observed between Anti-TPO and HDL. Similarly, there was a significant positive correlation between Anti-TG and LDL (r = 0.318, p = 0.001), triglyceride (r = 0.218, p = 0.022), and total cholesterol (r = 0.301, p = 0.001), but HDL correlation relationship was not detected.

Conclusion:

The relationship between thyroid autoimmunity and dyslipidemia has been demonstrated in our study even in the euthyroid phase. Whether antibody positive patients should be followed more closely for dyslipidemia and cardiovascular events is still controversial. This question will be answered with larger randomized controlled trials.

Reliability of Friedewald formula in patients with type 2 diabetes mellitus and its relation to lipid profile in diabetes regulation

Introduction: Many laboratories utilize Friedewald formula (FF) to analyze LDL cholesterol levels of patients including diabetes mellitus (DM). Therefore, it is essential to consider the coherence of results acquired by FF and direct measurement. The number of studies that investigated the effect of lipid parameters, especially TG/HDL cholesterol ratio, on the difference between the two methods is limited. The study was designed to compare LDL cholesterol values obtained by using FF with direct measurement, and to evaluate the relationship between diabetes regulation and lipid profile.

Material and Methods: In the cross-sectional study, 529 type 2 DM patients and 1703 non-DM subjects were divided into four groups regarding TG concentrations. Unlike other studies, the study focuses on direct LDL (DLDL) cholesterol levels obtained with the help of different DLDL cholesterol kits (n=20). The correlations were implemented between HbA1c and lipid profiles.

Results: It was determined that the bias% was over 10% in 24% of patients with 100-199 mg/dL TG levels. The parameter revealed that the most significant difference and the strongest correlation with HbA1c was TG/HDL cholesterol ratio in patients with type 2 DM.

Conclusions: In patients with type 2 DM, even if it was TG <200 mg/dL, LDL calculated with FF should be evaluated together with the TG/HDL cholesterol ratio. Otherwise, direct measurement can be recommended. This ratio is related to diabetes regulation and may be used to monitor patients..

Fasting Glucagon Level in Type 2 Diabetes and Impaired Glucose Tolerance and Its Association With Diabetes-Associated Clinical Parameters: A Study From Karachi, Pakistan

Aim and objective

The study aims to analyze fasting glucagon in patients with type 2 diabetes and impaired glucose tolerance and correlate it with anthropometric and biochemical parameters in a large proportion of Pakistani people with diabetes. 

Methodology

The participants of the study were categorized into three groups based on oral glucose tolerance test, as per American Diabetes Association guidelines. Group A consisted of normal glucose tolerance subjects (n=30), Group B consisted of subjects with impaired glucose tolerance (n=30), and Group C had full-blown subjects with type 2 diabetes (n=30). Biochemical parameters, such as fasting glucagon, fasting plasma and 2-hour glucose, glycated hemoglobin, and lipid profile, and anthropometric parameters, such as body mass index (BMI), waist and hip circumference, waist-to-hip ratio, and systolic and diastolic blood pressure, were measured.

Results

The mean values of fasting glucagon level in Group A, Group B, and Group C were 39.24±4.5, 44.5±8.25, and 49.02±9.15 pg/ml, respectively. Statistically significant difference was not found in fasting glucagon level among these groups (p-value 0.614). Fasting glucagon was positively and independently correlated with 2-hour plasma glucose, systolic blood pressure, diastolic blood pressure, BMI, hip and waist circumference, and hip-to-waist ratio in Group C. In Group B, fasting glucagon was positively correlated with 2-hour plasma glucose, BMI, and hip circumference, while it was not correlated with fasting plasma glucose in both groups. In Group A, fasting glucagon found positively correlated with systolic blood pressure and hip circumference.

Conclusion

Our observation suggests that fasting plasma glucose is not concomitant with glucagon levels; however, glucagon suppression, after glucose intake, was dysregulated in type 2 diabetes and impaired glucose tolerance. Moreover, glucagon is associated with central obesity in type 2 diabetic patients.

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Is data mining approach a best fit formula for estimation of low-density lipoprotein cholesterol?

Background:

With the change in the National Cholesterol Education Program ATP III guidelines, the risk of developing atherosclerosis has been now focused on total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Different treatment modalities are now targeted at lowering LDL cholesterol values. Hence greater emphasis is now led on the accurate and precise measurement of LDL cholesterol. Beta-quantification, though, is the best reference method for LDL cholesterol estimation, it has the disadvantage of being inconvenient in our routine practice. The new generation direct homogenous assay is now the method of choice. But being more expensive, various calculated methods have now been developed. This study is an attempt to compare different calculated formula with direct cholesterol assessment and to find out the best one.

Materials and Methods:

We compared LDL cholesterol measured by direct homogenous assay with the data mining approach (DM) and another calculated formula [Friedewald's Formula (FF) and Anandaraja Formula (AF)] in 266 samples with age greater than 18 years. Enrolled participants were divided into seven groups based upon their TG levels. Mean, percentage difference, and the correlation coefficient was assessed between calculated and direct LDL. Bland–Altman analysis was done to see the agreement between calculated vs direct LDL. All formulas were assessed among various TG levels with direct LDL by the Wilcoxon sign rank test.

Result:

1% level of significance was found between calculated and direct LDL with TG < 600 mg/dl. Mean and the percentage difference between direct and calculated LDL was lowest with the DM approach. Bland–Altman plot shows the best agreement of the DM approach with direct LDL.

Conclusion:

This study indicates that the DM approach is closer to direct LDL compared to FF & AF.

NDSP 05: Prevalence and pattern of dyslipidemia in urban and rural areas of Pakistan; a sub analysis from second National Diabetes Survey of Pakistan (NDSP) 2016-2017

Objectives

Dyslipidemia is a major risk issue for the development of cardiovascular disease. The aim of our study was to observe the pattern and prevalence of dyslipidemia in Pakistani population.

Methodology

This is a sub analysis of a population based second National Diabetes Survey of Pakistan (NDSP) 2016-2017 in adults aged 20 years or above, carried out from February 2016 to August 2017 across Pakistan. Multi stage sampling technique was used for the stratification of population, based on rural and urban domains. District wise clusters and sub clusters were selected i.e. 27 and 46 in number. Subjects, consented to participate were requested to come after an overnight fast for anthropometric measurements, oral glucose tolerance test and fasting lipid profile (except for subjects with self-reported diabetes). Dyslipidemia was identified using Adult Treatment Panel III guidelines.

Results

A total of 10,834 subjects (43.8% male and 56.2% female) having mean age of 43.8 ± 14.0 years, participated in the survey. Of the subjects studied, 39.3% had hypercholesterolemia, 48.9% had hypertriglyceridemia, 39.7% had high LDL-C levels while 83.9% men and 90% women had low HDL levels. High cholesterol and triglyceride levels were highest in 50-59 years age group, while high LDL and low HDL was most common in 40-49 years age group. Diabetes, obesity and hypertension were found to be the significant determinants for dyslipidemia.

Conclusion

Prevalence of dyslipidemia seems to be very high in Pakistan, necessitating an urgent call for early screening and effective management through lifestyle intervention and appropriate lipid lowering drugs to prevent this important cardiovascular risk factor.

Evaluation of different types of arsenic methylation and its relationship with metabolic syndrome in an area chronically exposed to arsenic

Evidence suggests that the relationship between arsenic metabolism and diseases, including metabolic syndrome, is complex. The aim of this study was to evaluate the different types of arsenic methylation and its association with metabolic syndrome in an arsenic endemic area. A cross-sectional study was conducted on 132 subjects from Shahid-Abad Village, Qazvin province, Iran (arsenic endemic area). Demographic characteristics, metabolic syndrome, and urinary arsenic species, including iAs (inorganic arsenic), MMA (monomethylarsonic acid), and DMA (dimethylarsinic acid) were measured for all patients and their relationship was analyzed by appropriate statistical methods. In this study, 34.5% of the participants had metabolic syndrome. The decrease in %MMA, increase in %DMA and increase in secondary methylation index (DMA/MMA) were associated with increased risk of metabolic syndrome (p<0.05). We did not find any association between the incidence of metabolic syndrome with primary methylation index (MMA/iAs) and %iAs (p>0.05). This study showed that the prevalence of metabolic syndrome was significantly higher in people with metabolic syndrome than in the general population. A closer examination revealed that the secondary methylation index is related to the metabolic syndrome and its components. Given the higher prevalence of cardiovascular disease and diabetes in patients with metabolic syndrome, it is necessary to change the pathogenesis of the disease using comprehensive management methods for decreasing patient complications.

Retrospective analysis of the cholesterol levels in a European mid-latitude population between 2007 and 2018: controversies and therapeutic implications

BACKGROUND AND AIM OF THE WORK

Coronary heart disease is the leading cause of morbidity and mortality in developed countries and its association with LDL-cholesterol has been well established. During the last decades statin therapy, and an healthy lifestyle, has proven highly effective in reducing cardiovascular event rates. Yet, there is still controversy among national guidelines and clinical practice with regard to LDL-cholesterol measurements. The aim of this study was to verify whether significant changes in cholesterol levels were observed over a relatively long (12 years) period. We also compared the Friedewald-calculated with directly-measured LDL cholesterol in order to verify whether the two methods were equivalent.

METHODS

We retrospectively analyzed 288000 data (total cholesterol, HDL, LDL both directly-measured and Friedewald-calculated, and triglycerides), from 57600 individuals, collected at the San Raffaele Hospital in Milan between 2007 and 2018. Data were statistically analyzed using a linear regression over the 12 years long period of time.

RESULTS

We observed a general decreasing trend in total cholesterol (and an increasing trend in HDL) and a decrease in triglycerides only in the male group. Directly-measured  LDL did not correlate well with calculated LDL.

CONCLUSION

The total cholesterol decrease and the corresponding increment in HDL was attributed to either an increased use of statin and/or an improvement of the general population dietary habits. The latter was further confirmed by the decrease in triglycerides observed in the male group. Based on our data, an alternative method for assessing atherogenics lipoproteins level has been proposed.

Friedewald's equation for calculating LDL-cholesterol: Is it the time to say "Goodbye" and adopt direct LDL cholesterol methods?

Objectives:

To measure correlation and concordance between measured LDL cholesterol (mLDLc) and Friedewald’s calculated LDL cholesterol (cLDLc). To compare the mLDLc and cLDLc values for various anthropometric measures and biochemical indices including insulin resistance, nephropathy, glycated hemoglobin and triglycerides.

Methods:

Two hundred thirty two subjects were included in this cross-sectional analysis from Jan-2016 to July-2017 from a target population visiting PNS HAFEEZ hospital. Mean age of the subjects was 46.56(±11.95) years (n=232). These subjects underwent clinical evaluation including measurement of anthropometric measurements, biochemical testing for fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), lipid profile, urine albumin creatinine ratio (UACR), and insulin. Correlation and concordance between mLDLc and Friedewald’s cLDLc were measured. Finally, Comparison of risk evaluation for mLDLc and cLDLc between groups formulated based upon UACR (Based upon a cut off of 2.5 mg/g) and fasting triglycerides (Group-1 :< 1.0 mmol/L, Group-2: 1.0-1.99 mmol/L and Group-3 :> 1.99 mmol/) was carried out.

Results:

There was significant positive linear correlation between mLDLc and cLDLc [r=0.468, <0.001]. Kendall’s Coefficient of concordance between mLDLc and cLDLc was 0.055 (p<0.001). Differences evaluated by one way ANOVA analysis for mLDLc between various triglycerides groups were only significant between group-1 and group-2 [{Group-1:Mean=2.40, (2.19-2.61), n=43}, {Group-2:Mean=2.81, (2.69-2.92), n=136}, [{Group-3:Mean=2.59,(2.37-2.81), n=53}],(p=0.004) in comparison to cLDLc [{Group-1:Mean=2.63, (2.43-2.84), n=43}, {Group-2:Mean=2.85, (2.76-2.93), n=136}, [{Group-3:Mean=2.75, (2.60-2.90), n=53}]. Calculated method for LDLc showed higher UACR than mLDLc. (p=0.021)

Conclusion:

cLDLc over estimates LDL-cholesterol in comparison to mLDLc. The correlation between cLDLc and mLDLc was only moderate. However, cLDLc provided better degree of risk prediction for nephropathy and glycated hemoglobin than mLDLc.

Prevalence of diabetes, pre-diabetes and associated risk factors: second National Diabetes Survey of Pakistan (NDSP), 2016-2017

OBJECTIVE

The second National Diabetes Survey of Pakistan (second NDSP) was planned to ascertain the updated prevalence of diabetes, pre-diabetes and associated risk factors at the national and provincial levels.

RESEARCH DESIGN AND METHODS

The survey was conducted by using multistage clustering technique in all four provinces of Pakistan from February 2016 to August 2017. An estimated sample size of 10 800 was calculated using probability sampling and multistage stratified sampling technique. Twenty-seven clusters were selected out of total 213 clusters from all four provinces (strata) of Pakistan. A total of 46 subclusters were selected by using the 'Rule of thumb'. Out of 12 486 targeted individuals, 10 834 study subjects finally participated in the study (87% response rate). Seventeen trained teams collected data using the structured questionnaire. The clinical and anthropometric measurements included height, weight, blood pressure, waist circumference and waist-to-hip ratio while the blood tests included Oral Glucose Tolerance Test (OGTT), haemoglobin A1c and fasting lipid profiles. WHO criteria were used for the diagnosis of diabetes and pre-diabetes.

RESULTS

Overall weighted prevalence of diabetes was 26.3%, of which 19.2% had known diabetes, and 7.1% were newly diagnosed people with diabetes. Prevalence of diabetes in urban and rural areas was 28.3% and 25.3%, respectively. Prevalence of pre-diabetes was 14.4% (15.5% in urban areas and 13.9% in rural areas). Age greater than or equal to 43 years, family history of diabetes, hypertension, obesity and dyslipidaemia were significant associated risk factors for diabetes.

CONCLUSION

The findings of the 2nd NDSP imply that diabetes has reached epidemic proportion and urgently need national strategies for early diagnosis and effective management as well as cost-effective diabetes primary prevention programme in Pakistan.

Effects of blood lipid stability on progression of carotid atherosclerosis

Objective:

To evaluate the effects of blood lipid stability on progression of carotid atherosclerosis.

Methods:

A total of 416 patients who had physical examination in our hospital annually from January 2010 to December 2015 were selected and divided into a progression group (n=216) and a non-progression group (n=200) according to the intima-media thickness measured by carotid ultrasound. The levels of lipid-related parameters within five years were retrospectively analyzed to calculate the smoothness index (SI = x±/s).

Results:

The cross-sectional TG, HDL-C, ApoAI, ApoB, ApoE and Lpa levels were similar in the two groups (p>0.05). The non-progression group had significantly higher TC ((4.15±0.82 vs. 4.50±1.04) mmol/L) and LDL-C ((2.53±0.76 vs. 2.99±1.03) mmol/L) levels than those of the progression group (p<0.05). The progression group had significantly lower TC SI (5.29±1.28 vs. 5.65±1.76), TG SI (2.13±0.71 vs. 2.79±0.82), LDL-C SI (3.66±1.17 vs. 4.36±1.58), ApoB SI (3.37±0.88 vs. 3.62±0.95) and Lpa SI (1.53±0.49 vs. 1.62±0.43) than those of the non-progression group (p<0.05).

Conclusion:

Compared with cross-sectional results, SI was better correlated with the progression of atherosclerosis. The progression group had lower SI values.