Association of serum lipids with level of blood pressure in type 2 diabetic patients

Controlling Lipids AIDS in the Prevention of Type 2 Diabetes, Hypertension, and Cardiovascular Diseases

BACKGROUND

Abnormal lipid profiles are a characteristic feature of persons with chronic conditions in which the diabetic populations are recognized as the dominant group, regardless of gender and ethnicity worldwide. This study was conducted to identify and evaluate the abnormalities of serum lipid profiles in both nondiabetic and diabetic persons.

METHODS

This study was a case-control investigation conducted between 2013 and 2015. The study enrolled 266 patients from the North Central and South West Regional Health Authorities of Trinidad. Of the 266 patients recruited, 126 were diabetic and 140 were nondiabetic.

RESULTS

Our study observed that dyslipidemia was present among the nondiabetic populations as the nondiabetics had 55 women and 20 men with high cholesterol, 22 women and 14 men with high triglyceride (TG), 30 women and 25 men with low high-density lipoprotein cholesterol (HDL-C), 42 women and 21 men with high low-density level-cholesterol (LDL-C), 13 women and 8 men with high very low-density lipoprotein (VLDL), and also 30 women and 11 men with body mass index (BMI) over 30 kg/m². We also observed that diabetic women had significantly lower TGs (P = 0.019) and higher HDL-C (P = 0.001) and LDL (P = 0.003) when compared with the diabetic men. In addition, the nondiabetic females also had higher HDL-C (P = 0.045) when compared to their male counterparts. Both diabetic and nondiabetic women exhibited significantly higher BMI of P = 0.000. A negative correlation was obtained among TGs and HDL (r = -0.356, n = 83, P = 0.001) and a positive correlation was observed among LDL and HDL (r = 0.230, n = 86, P = 0.035).

CONCLUSIONS

This study observed the incidences in the abnormalities of serum lipid profiles in both nondiabetic and diabetic persons. It also presents the high occurrence of nondiabetic women with dyslipidemia as they presented with high cholesterol, high TG, low HDL-C, and high VLD-L with BMI over 30 kg/m².

Correlation between Serum Lipid Profile with Anthropometric and Clinical Variables in Patients with Type 2 Diabetes Mellitus

BACKGROUND

The problem of dyslipidemia is high in patients with diabetes mellitus. There is ample evidence that abnormalities in lipid metabolism are important risk factors for increased incidence of diabetes associated complications. The most important risk indicators for these complications are lipid profile abnormalities. Therefore, the aim of this study was to assess the correlation between serum lipid profile with anthropometric and clinical variables among type 2 diabetes mellitus patients.

METHODS

A comparative cross sectional study was conducted at University of Gondar Hospital from February to April in 2015. A total of 296 participants (148 case and 148 healthy controls) were selected using systematic random sampling technique. Socio-demographic characteristics and clinical data were collected using pretested structured questionnaire incorporating the WHO Stepwise approach. Fasting venous blood sample was collected for blood sugar; lipid profile investigations and the blood levels were determined by Bio Systems A25 Chemistry Analyzer (Costa Brava, Spain). Independent sample t-test and Man Whitney U test were used to compare means. P-value < 0.05 was considered statistically significant.

RESULTS

Overall, T2DM patients had significantly higher total cholesterol ([205.4±50.9vs184.9±44.1]mg/dl), low density lipoprotein ([113.1±43.2vs100.1±36.4] mg/dl) and triacylglycerol ([189.22± 100.9 vs 115.13±59.2] mg/dl), and significant decline of high density lipoprotein cholesterol ([56.5±20.4vs62.1±13] mg/dl) as compared to healthy controls, respectively. Triacylglycerolemia was significantly associated with the risk of cardiovascular disease (AOR: 1.015; 95%CI: 1.010-1.021). Evident correlation was observed between anthropometric and clinical variables with lipid profile.

CONCLUSION

Higher serum levels of fasting blood sugar, total cholesterol, low density lipoprotein cholesterol, and triacylglycerol and lower levels of high density lipoprotein cholesterol are found in type 2 diabetes mellitus patients. Thus, DM patients are more prone to dyslipidemia which is an important risk factor for atherosclerosis and coronary heart disease.

Predictive Factors of Hospital Mortality Due to Myocardial Infarction: A Multilevel Analysis of Iran's National Data

Background:

Regarding failure to establish the statistical presuppositions for analysis of the data by conventional approaches, hierarchical structure of the data as well as the effect of higher-level variables, this study was conducted to determine the factors independently associated with hospital mortality due to myocardial infarction (MI) in Iran using a multilevel analysis.

Methods:

This study was a national, hospital-based, and cross-sectional study. In this study, the data of 20750 new MI patients between April, 2012 and March, 2013 in Iran were used. The hospital mortality due to MI was considered as the dependent variable. The demographic data, clinical and behavioral risk factors at the individual level and environmental data were gathered. Multilevel logistic regression models with Stata software were used to analyze the data.

Results:

Within 1-year of study, the frequency (%) of hospital mortality within 30 days of admission was derived 2511 (12.1%) patients. The adjusted odds ratio (OR) of mortality with (95% confidence interval [CI]) was derived 2.07 (95% CI: 1.5–2.8) for right bundle branch block, 1.5 (95% CI: 1.3–1.7) for ST-segment elevation MI, 1.3 (95% CI: 1.1–1.4) for female gender, and 1.2 (95% CI: 1.1–1.3) for humidity, all of which were considered as risk factors of mortality. But, OR of mortality was 0.7 for precipitation (95% CI: 0.7–0.8) and 0.5 for angioplasty (95% CI: 0.4–0.6) were considered as protective factors of mortality.

Conclusions:

Individual risk factors had independent effects on the hospital mortality due to MI. Variables in the province level had no significant effect on the outcome of MI. Increasing access and quality to treatment could reduce the mortality due to MI.

Diabetes mellitus and renal failure: Prevention and management

Nowadays, diabetes mellitus (DM) and hypertension are considered as the most common causes of end-stage renal disease (ESRD). In this paper, other than presenting the role of DM in ESRD, glucose metabolism and the management of hyperglycemia in these patients are reviewed. Although in several large studies there was no significant relationship found between tight glycemic control and the survival of ESRD patients, it is recommended that glycemic control be considered as the main therapeutic goal in the treatment of these patients to prevent damage to other organs. Glycemic control is perfect when fasting blood sugar is less than 140 mg/dL, 1-h postprandial blood glucose is less than 200 mg/dL, and glycosylated hemoglobin (HbA1c) is 6-7 in patients with type 1 diabetes and 7-8 in patients with type 2 diabetes. Administration of metformin should be avoided in chronic renal failure (CRF) because of lactic acidosis, the potentially fatal complication of metformin, but glipizide and repaglinide seem to be good choices.

Antioxidant plants and diabetes mellitus

The incidence of diabetes mellitus (DM) is increasing rapidly and it is expected to increase by 2030. Other than currently available therapeutic options, there are a lot of herbal medicines, which have been recommended for its treatment. Herbal medicines have long been used for the treatment of DM because of the advantage usually having no or less side-effects. Most of these plants have antioxidant activities and hence, prevent or treat hard curable diseases, other than having the property of combating the toxicity of toxic or other drugs. In this review other than presenting new findings of DM, the plants, which are used and have been evaluated scientifically for the treatment of DM are introduced.

Herbal versus synthetic drugs; beliefs and facts

Herbal therapy is a holistic therapy, integrating emotional, mental and spiritual levels. Life style, emotional, mental and spiritual considerations are part of any naturopathic approach. The use of herbs does not generally involve "drug" actions or adverse effects. Although medicinal plants are widely used and assumed to be safe, however, they can potentially be toxic. Where poisoning from medicinal plants has been reported, it usually has been due to misidentification of the plants in the form, in which they are sold, or incorrectly preparation and administration by inadequately trained personnel. There are some "drug like" plants remedies that their actions approach that of pharmaceuticals. Herbalists use these plants in treatment strategies and in countries such as Britain their vast availability is restricted by law. Digitalis is one of these examples and the number of these plants is not a lot. The mechanisms by which the herbs generally act are not established, however, most of medicinal plants possess antioxidant activities. The plants have been shown to effective by this property is various conditions including cancer, memory deficit and Alzheimer, atherosclerosis, diabetes and other cardiovascular diseases. Antioxidant activities of herbal medicines are also effective in reducing the toxicities of toxic agents or other drugs.

Atherosclerosis: process, indicators, risk factors and new hopes

Background:

Atherosclerosis is the major cause of morbidities and mortalities worldwide. In this study we aimed to review the mechanism of atherosclerosis and its risk factors, focusing on new findings in atherosclerosis markers and its risk factors. Furthermore, the role of antioxidants and medicinal herbs in atherosclerosis and endothelial damage has been discussed and a list of important medicinal plants effective in the treatment and prevention of hyperlipidemia and atherosclerosis is presented.

Methods:

The recently published papers about atherosclerosis pathogenesis and herbal medicines effective in the treatment and prevention of hyperlipidemia and atherosclerosis were searched.

Results:

Inflammation has a crucial role in pathogenesis of atherosclerosis. The disease is accompanied by excessive fibrosis of the intima, fatty plaques formation, proliferation of smooth muscle cells, and migration of a group of cells such as monocytes, T cells, and platelets which are formed in response to inflammation. The oxidation of low density lipoprotein (LDL) to Ox-LDL indicates the first step of atherosclerosis in cardiovascular diseases. Malondialdehyde factor shows the level of lipoperoxidation and is a sign of increased oxidative pressure and cardiovascular diseases. In special pathological conditions such as severe hypercholesterolemia, peroxynitrite concentration increases and atherosclerosis and vascular damage are intensified. Medicinal plants have shown to be capable of interacting these or other pathogenesis factors to prevent atherosclerosis.

Conclusions:

The pathogenesis factors involved in atherosclerosis have recently been cleared and the discovery of these factors has brought about new hopes for better prevention and treatment of atherosclerosis.

Relationship between risk factors and in-hospital mortality due to myocardial infarction by educational level: a national prospective study in Iran

Introduction

Since no hospital-based, nationwide study has been yet conducted on the association between risk factors and in-hospital mortality due to myocardial infarction (MI) by educational level in Iran, the present study was conducted to investigate relationship between risk factors and in-hospital mortality due to MI by educational level.

Methods

In this nationwide hospital-based, prospective analysis, follow-up duration was from definite diagnosis of MI to death. The cohort of the patients was defined in view of the date at diagnosis, hospitalization and the date at discharge (recovery or in-hospital death due to MI). 20750 patients hospitalized for newly diagnosed MI between April, 2012 and March, 2013 comprised sample size. Totally, 2511 deaths due to MI were obtained. The data on education level (four-level) were collected based on years of schooling. To determine in-hospital mortality rate and the associated factors with mortality, seven statistical models were developed using Cox proportional hazards models.

Results

Of the studied patients, 9611 (6.1%) had no education. in-hospital mortality rate was 8.36 (95% CI: 7.81-8.9) in women and 6.12 (95% CI: 5.83-6.43) in men per 100 person-years. This rate was 5.56 in under 65-year-old patients and 8.37 in over 65-year-old patients. This rate in the patients with no, primary, high school, and academic education was respectively 8.11, 6.11, 4.85 and 5.81 per 100 person-years. Being woman, chest pain prior to arriving in hospital, lack of thrombolytic therapy, right bundle branch block, ventricular tachycardia, smoking and ST-segment elevation myocardial infarction were significantly associated with increased hazard ratio (HR) of death. The adjusted HR of mortality was 1.27 (95% CI: 1.06-1.52), 0.93 (95% CI: 0.77-1.13), 0.72 (95% CI: 0.57-0.91) and 0.82 (95% CI: 0.66-1.01) in the patients with respectively illiterate, primary, secondary and high school education compared to academic education.

Conclusion

A disparity was noted in post-MI mortality incidence in different educational levels in Iran. HR of death was higher in illiterate patients than in the patients with academic education. Identifying disparities per educational level could contribute to detecting the individuals at high risk, health promotion and care improvement by relevant planning and interventions in clinics and communities.