ABSTRACT
Prevalence of type 2 diabetes mellitus [DM] in the Middle East is rising, and dyslipidemia in diabetics contributes to the increasing incidence of cardiovascular disease in this population. Data on the prevalence of dyslipidemia in diabetics in the Middle East and whether it differs from that in the West are scarce. The Jordan Hyperlipidemia And Related Targets Study [JoHARTS] measured levels of fasting serum total cholesterol [TC], triglycerides [TG], low- and high-density lipoprotein cholesterol [LDL-C and HDL-C] in mg/dl in 5000 individuals evaluated at four tertiary-care centers and outpatient clinics. None was on lipid lowering agents at the time of enrollment. The diabetic subgroup [n=1410, 28%] was studied in JoHARTS-3 and consisted of 863 men [61%] and 547 women [39%]. Compared with nondiabetic men, those with DM had lower mean HDL-C level [38.0+10.6 vs 39.4+15.7, P=0.006] and higher mean TG level [186+78.9 vs 169+78.2, P<0.0004], but TC and LDL-C levels were similar in the two groups [208 vs 207; P=0.43, and 130 vs 132; P=0.10, respectively]. Similarly, diabetic women had lower HDL-C [43.8+14.2 vs 47.7+12.2, P<0.0001] and higher TG [189+78.8 vs 149+69.7, P<0.0001] than nondiabetic women. When diabetes coexisted with smoking, the HDL-C levels weree lower than levels among nondiabetic nonsmokers [36.9+10.1 vs 43.2+13.9, P<0.0001], and the TG levels were higher [201.5+80.9 vs 166.6+75.1, P<0.0001]. LDL-C levels <100 were found in 19% of diabetic with CAD, and levels <70 in 5% only. With each 1% increase in glycated hemoglobin [HbA1c] level; there were significant decreases in HDL-C levels [43.1 among those with Hb A1c 6-7% compared with 37.8 for Hb A1c >10%, P=.027] and significant increase in TG levels [185 to 244, P=0.02]
Subject(s)
Female , Humans , Male , Diabetes Mellitus, Type 2/complications , Dyslipidemias/etiology , Dyslipidemias/complications , Hyperlipidemias , Cardiovascular Diseases/etiologyABSTRACT
Cardiovascular disease [CVD] is the number one cause of death in women. Premenopausal women rarely get CVD unless they are diabetics, smokers, or have hereditary hypercoagulable states. However, after the menopause and with the loss of the protective estrogenic protection, incidence of CVD increases substantially. Epidemiological studies showed a cardiovascular benefit among hormone replacement therapy [HRT] users, but the bias in these uncontrolled studies may offset any firm conclusion on the role of HRT for CVD prevention. Randomized clinical HRT trials in primary and secondary cardiovascular prevention will be discussed including HERS I and II, WHI, WISDOM, ESPRIT, ERA, and KEEPS. Due to the lack of benefit of combined HRT in preventing CVD, emphasis is now shifting towards other options such as statins, and selective estrogen receptor modulators
Subject(s)
Humans , Female , Hormone Replacement Therapy , Estrogen Replacement Therapy , Risk FactorsABSTRACT
we studied the rate of cigarette smoking cessation among jordanians who sustained acute coronary events and whether undergoing coronary revascularization would predict a higher rate of quitting smoking. Materials and methods in a two year period, smokers who were admitted for acute coronary events [unstable angina and myocardial infarction] were followed up for 6-120 months after the event to study their smoking behavior [i.e. continued smoking or smoking cessation of 397 patients [mean age 55 years, 97% were men] only 22.7% quit and the remaining 77.3% continued to smoke at the end of the follow up period. Smoking cessation was significantly higher among patients who had coronary revascularization than among those treated medically [32.8%vs.l4.8% respectively, p=0.0002]. Smoking cessation, however, was not dependent on whether the patients had undergone percutaneous or surgical revascularization [31.1%vs. 35.2% respectively, p=0.57] the rate of smoking cessation among Jordanians who sustained acute coronary syndrome is low even if they had a cardiac revascularization procedure