International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 4(7), April, 2012

Pages: 11-15

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DIABETIC CARDIOVASCULAR COMPLICATIONS AND DYSLIPIDEMIA: A HOSPITAL BASED CROSS SECTIONAL STUDY IN NORTHWEST INDIA

Author: Sharma Ashish, Agrawal Apurva, Sharma Anita

Category: Healthcare

Abstract:Aim: To investigate the strength of association of each parameter of deranged lipid profile with diabetic cardiovascular complications Methods: This was a hospital based cross sectional study which included 150 diabetic patients who visited shree krishna hospital from May 2008 to April 2009. Lipid profile of all the patients was estimated by fully autoanalyser, cardiovascular complications assessed by Echo-cardio graphic changes and Electro cardiogram (ECG) changes. Results: The prevalence of dyslipidemia is higher in diabetic population in our study. Serum cholesterol >240 mg/dl was seen in 14%, serum triglycerides >160 mg/dl was seen in 43.33 %, raised LDL (low density lipoproteins) >130 mg/dl in 35.33 %, VLDL (very low density lipoproteins) >40 mg/dl in 25.33% and low levels of HDL (high density lipoproteins)< 40 mg/dl were seen in 46.66 %. Though duration of disease, use of statins, abnormal level of cholesterol and lipoproteins also influence the development of diabetic cardiovascular complications,but on multiple logistic regression analysis, CVD (cardiovascular disease) had strong correlation with high levels of LDL only. Conclusion: Our study showed that Lipid profile abnormalities which are very common in type 2 diabetes, have a great influence on CVD. Estimated cardiovascular risk can be correlated with abnormal lipid profile, especially high level of LDL.

Keywords: Dyslipidemia, Type II Diabetes, Cardiovascular complications

Full Text:

INTRODUCTION
Diabetes Mellitus and its associated complications have become a public health problem of considerable magnitude. Cardiovascular disease (CVD) is the most prevalent complication and is associated with excess morbidity and mortality in diabetic patients. (1)The etiopathogenesis of the longterm complications of diabetes is not fully understood and controversies exist about why they occur in some patients and not in others. (2) Though role of dyslipidemia in the development of diabetic complications is well known but data regarding individual parameter of deranged lipid profile are lacking. Various risk factors act synergistically for the development of cardiovascular complications in type II diabetes and the contribution of individual risk factor is yet to be clearly identified and quantified. (3) Thus the present study aimed to assess the effect of dyslipidemia on cardiovascular complications in western India.

MATERIAL AND METHODS
Study population

In this hospital based cross-sectional prospective study, total 150 type II diabetic patients attending diabetic clinic and medicine OPD at shree krishna hospital, PSMC, karamsad during May 2008 to April 2009 were included. Patients were confirmed for diabetes by clinical and biochemical diagnosis based on American Diabetes Association revised criteria. (4) Approval from the institutional ethics committee was taken prior to study. The patients included in the study were informed about the study in brief, in their local language, and then written consent was taken from them. Study design Diabetic patients were evaluated for presence of cardiovascular complications which was assessed by either Electrocardiogram or Echocardiographic changes. Lipid profile was done by fully-auto analyzer (ERBA -XL-300). Triglyceride level was estimated by GPO (trinder) method. (5) Total cholesterol was estimated by CHOD-POD method (6), while HDL estimation was done by phosphotungustic method. (7) Blood glucose was estimated by glucose oxidase method (8) and glycosylated hemoglobin by immunoturbidometric method. (9) Estimated values of total cholesterol >240 mg/dl, serum triglycerides >160 mg/dl, HDL 130 mg/dl and VLDL >40 mg/dl were considered as abnormal. Statistical analysis Means or proportions for baseline clinical and laboratory characteristics were computed for subjects with and without cardiovascular risk. Ttest was used to compare means and chi square test was used to compare proportions. Significance tests were two tailed and p-values less than 0.05 were considered statistically significant. Multiple Logistic regression analysis was used to assess effect of individual variable in the development of cardiovascular complication of diabetes. RESULTS The details of demographic profile of the study population revealed that the mean age of the study population was 60.4 years, with average duration of diabetes 9.7 years. Mean fasting blood sugar was 161.9 ± 51.7 mg/dl and mean glycosylated hemoglobin was found to be 8.2 %. Mean serum cholesterol was 182.9 ± 50 mg/dl, serum HDL was 40.6 ± 13.2 mg/dl, serum LDL was 110.3 ± 41.3 mg/dl, serum VLDL was 35.8 ± 23.8 mg/dl and serum triglyceride (TG) was 175.8 ± 110 mg/dl. Data regarding lipid profile showed that out of 150 patients, hypertriglyceridemia is most common abnormality in diabetic patients, followed by high level of LDL and VLDL. Serum TG levels were high (>160 mg/dl) in 43.33 % patients, while high LDL level (>130 mg/dl) were found in 35.33% patients. Comparison of means revealed that duration of disease, serum cholesterol, serum LDL, serum VLDL and serum triglyceride levels were significantly associated with the cardiovascular complication, with p value < 0.05. While age of patients, serum HDL levels, fasting blood sugar levels (FBS) and PP2BS levels did not have statistically significant association with cardiovascular complication. (Table-1) Use of statins in diabetic patients was found to be significantly associated with reduction of cardiovascular complications. Sex of the patients, glycosylated hemoglobin levels and smoking were not found to be significantly associated with the risk of cardiovascular complications, with p values more than 0.05. (Table-2) On application of multiple logistic regression and after adjusting all the variables mutually, only serum LDL level was found to be significantly associated with the development of cardiovascular complication in diabetes patients with approximately a threefold increase in the  risk of cardiovascular complications (OR 2.7, 95% CI 1.5613 to 4.8532). (Table-3) DISCUSSION The present study showed the prevalence of dyslipidemia in diabetic population of west India comprising rural population. Dyslipidemia is an established risk factor for CAD in patients with type II diabetes, (10, 11) which include low HDL levels, raised triglycerides and raised LDL levels. LDL is a major determinant of atherosclerosis in patients with diabetes, results are consistent with study of R.P. Agrawal et al, in which changes in LDL particle composition such as density, oxidation potential and glycation, render even normal LDL levels as highly atherogenic. (3) The Strong Heart Study, which was an American Indian population based study, concluded that each 10 mg/dl increase in LDLcholesterol corresponded to a 12% increase in cardiovascular risk. (12). Similar information was also observed in present study, in which LDL-cholesterol was the most important independent variable in the model used for multivariate analysis, while from baseline data of the United Kingdom Prospective Diabetes Study (UKPDS), Stratton IM et al revealed that both decreased HDL and elevated LDL predict CHD. (13) There were some limitations in the present study, sample size was small and it was a hospital based study, so can‘t represent whole population. There is a need to perform such studies on larger and community based population. CONCLUSION In conclusion, the results of our study showed that in type 2 diabetes population of western India, estimated cardiovascular risk correlated with abnormal lipid profile, especially high serum levels of LDL. These data could explain the failure of intensive glycemic control in reducing cardiovascular events observed in diabetic patients. Duration of disease also had strong impact on diabetic complications. Patients on hypolipidemic drugs had an inverse relationship with the development and progression of cardiovascular complications, while patient‘s age, sex, and smoking behavior did not show statistically significant asssociation. More studies are required for development of appropriate preventive and treatment strategies to reduce diabetic cardiovascular complications. ACKNOWLEDGEMENT We acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. We are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

1. Schalkwijik CG, Stehouwer CDA. Vascular complications in diabetes mellitus: the role of endothelial dysfunction. Clin Sci 2005;109:143-59.

2. Zimmet P, Alberti KGMM, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001 Dec 13;414:782-7.

3. Agrawal RP, Sharma P, Pal M, Kochar A, Koachar DK. Magnitude of dyslipedemia and its association with micro and macro vascular complications in type 2 diabetes: a hospital based study from Bikaner (Northwest India). Diabetes Res Clin Pract 2006;73:211-4.

4. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2004; 27:s5-s10.

5. McGowan MW, Artiss JD, Strandbergh DR, Zak B. A peroxidase-coupled method for the colorimetric determination of serum triglycerides. Clin Chem 1983; 29:538-42

6. Richmond W. Preparation and properties of cholesterol oxides from nocardia sp. and its application to the enzymatic assay of total cholesterol in serum. Clin Chem 1973;19:1350-6.

7. Rifal N, Warnick GR editors. Laboratory measurement of lipids, lipoproteins and apolipoproteins. Washington DC: American Association of Clinical Chemistry (AACC) press; 1994 p. 21 – 42.

8. Trinder P. Determination of Glucose in blood using glucose oxidase with an alternate oxygen acceptor. Ann Clin Biochem 1969;6:24–7.

9. Trivelli LA, Ranney HM, Lai HT. Hemoglobin components in patients with diabetes mellitus. N Engl J Med 1971;284:353-7.

10. Adult Treatment Panel. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143-421.

11. Berthezène F. Diabetic dyslipidaemia. Br J Diabetes Vasc Dis. 2002;2(1):S12–7.

12. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention trail. Diabetes Care 1993;16:434–44.

13. Stratton IM, Adler AI, Neil HAW, Matthews DR, Manley SE, Cull CA et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405–12.


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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

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A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
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A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
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A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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