Plasma testosterone level in male patients with metabolic syndrome

Mild hypogonadism in men have been associated with features of metabolic syndrome. The aim of the present work is to study the role of serum testosterone in middle aged men with metabolic syndrome. The study group comprised 50 middle aged men who fulfilled the definition criteria of metabolic syndrome according to WHO definition. They were divided into two groups: Group [1]: Included 19 patients with IHD [mean age 50.6 +/- 5.1 years]. Group [2] of 2]: Included 31 patients without IHD [mean age of 50.6 +/- 5.1 years]. A group of 20 age matched healthy men was used as a control group their age ranged from 41-57 years with a mean of 49.1 +/- 5.4 years. All patients and controls were subjected to thorough clinical examination including blood pressure, weight, height, BMI and WHR; investigations including ECG, CBC, fasting and postprandial blood sugar, lipid profile and serum uric acid. Total serum testosterone was measured in patients and controls by the use of enzyme chemiluminescent assay on the immulite autoanalyzer. Serum total testosterone level ranged from 0.4-7.8ng/ml in patients group with a mean of 3.8+1.8 while in the control group it ranged from 2.4-9.3ng/ml with a mean of 5.3 +/- 1.9. Comparing serum testosterone level in both groups it was found to be statistically highly significant lower in patients group than in control group p=0.003. A significant negative correlation was found between serum total testosterone .level [3.8 +/- 1.8ng/ml] and age [50.6 +/- 5.1ys] in the group of patients. r=0.32 p=0.02. A highly significant negative correlation was detected between serum total testosterone level and fasting blood sugar, serum triglycerides, serum total cholesterol, serum uric acid anddiastolic blood pressure. [r=0.728, 0.872, 0.7370, 0.990 and 0.697 respectively]. A highly significant positive correlation was detected between serum total testosterone and HDL [r=0.935] and haemoglobin [r=0.879]. Statistically insignificant negative correlation was detected between serum total testosterone level and age, WHR, postprandial blood sugar and LDL. Statistically insignificant positive correlation was detected between serum total testosterone level and BMI. Serum total testosterone level was found to be statistically insignificant lower in group [1] with evidence of IHD [3.45 +/- 1.49ng/ml] than in group [2] patients without evidence of IHD [3.97 +/- 1.99ng/ml], p=0.336. We have concluded that middle aged men with metabolic syndrome have lower testosterone level than normal population. There is a possible role of testosterone in the development or progression of metabolic syndrome and/or its components according to WHO definition

Evaluation of serum plasminogen activator inhibitor-1 [PAI-1] in type 2 diabetic patients

This study was performed on 20 nonsmoking, normotensive type 2 female diabetic patients with normal renal and hepatic functions. They were divided into two groups: Group 1 included ten controlled type 2 diabetic patients on oral hypoglycemics with a mean age of 53.9 +/- 5.23 years [range 45-60 years] and mean diabetes duration of 5.7 +/- 2.6 years and group 2 included ten uncontrolled type 2 diabetic patients on oral hypoglycemics with a mean age of 49 +/- 5.01 years [range 40-56 years] and mean diabetes duration of 11.6 +/- 3.7 years. A determination of plasma insulin level using enzyme linked immunosorbent assay [ELISA] and the plasma level of plasminogen activator inhibitor-1 [PAI-1] was done using Biopool Tint Elize test. Ten age and sex matched normal subjects were included in the study as a control group. The results of this study indicated that among type 2 diabetic patients, PAI-1 was elevated among uncontrolled diabetic patients. It proved to have an important role in the development of ischemic heart disease as an example of macrovascular diabetic complication, especially if associated with dyslipidemia

Plasma level of Von willebrand factor in type 2 diabetics with cerebrovascular stroke, with and without microalbuminuria

The risk of cerebrovascular stroke is known to be markedly elevated in patients with long duration of type 2 diabetes mellitus[1] . Diabetes mellitus is a risk factor for ischemic stroke, and is assosciated with higher mortality and worse functional outcome[2]. Microalbuminuria is associated with cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus[3] Links between endothelial dysfunction [elevated level of Von Willebrand Factor], atherosclerosis and diabetes mellitus have been increasingly recognized. One of the earliest discernible atherogenic changes in diabetes is endothelial dysfunction. The aim of the present study is to examine the concept suggesting that microaluminuria in combination with high level of plasma Von Willebrand factor [as a marker of endothelial dysfunction] is a strong predictor for macrovascular disease [evidence by stroke] than microalbuminuria alone in type 2 diabetic patients. The study group consisted of thirty normotensive, non smoking diabetic patients with normal renal function selected from the internal medicine outpatient clinic of Kasr El A ini hospital. They were divided into two groups: group [l] included 10 type 2 diabetic patients with cerebrovascular stroke [6 males and 4 females], with a mean age 56 +/- 8.39 years [range 43-69 years],mean diabetic duration 11.6 +/- 3.7 years . Group [2] included 20 type 2 diabetic patients without cerebrovascular stroke [9 males and 11 females] with a mean age 55.5 +/- 8.57 years [range 43-69 years], mean diabetic duration 5.7 +/- 2.6years .Ten age, sex and weight matched healthy subjects [4male and 6 female] with a mean age 52 +/- 7.1 years [range 43-62 years] were included as a control group. Urinary albumin excretion, was assessed qualitatively using the micral test [Boehringer Manheim, Germany] and quantitatively using double antibody albumin procedure.Plasma level of von- Willebrand factor using ELISA procedures to measure vWf:Ag generally expressed in relative percent [%] as compared to pooled normal plasma . Carotid IMT was evaluated using high resolution B-modeUltrasonography. Ten diabetic patients with cerebrovascular stroke had a significant higher fasting [p= 0.0001], postprandial blood glucose [p=0.0001], cholesterol [0.001], triglycerides [p-0.02], low denisty lipoprotein [p=0.01], microalbuminuria [74.689 +/- 66.24 vs 4.166 +/- 5.6 U gm /min, p=0.003], plasma level of vWf [190.0 +/- 22.60 vs 85.50 +/- 23.74%, p=0.002] and carotid artery IMT [1.14 +/- 0.388 vs 0.4 +/- 0.06 mm, p=0.001] compared to the control group [10 subjects]. Diabetic patients with cerebrovascular-stroke [group 1] had significantly higher vWF [190.0 +/- 22.60 vs 153.35 +/- 22.7%,p=0.05], carotid IMT [1.14 +/- 0.388 vs 0.9 +/- 0.45 mm, p= p=0.04], low density lipoprotein [79.1 +/- 53.19 vs 53 .05 +/- 23.11 mg/dl, p=0.002] as well as fasting [p=0.05] and post prandial blood glucose [p=0.009], compared to twenty uncomplicated diabetic patients [group 2].Six diabetic patients with stroke and microaluminuria had a significant higher level of vWf [190.83 +/- 21.07 vs 93.750 +/- 14.36, p= 0.003], carotid IMT [p=0.009] low density lipoprotein [p=0.001], as well as fasting [p= 0.008], post prandial blood glucose [p=0.001], Cholesterol [p=0.03] and triglyceride level [p=0.04] compared to four diabetic patients with stroke but without microalbumiuria .Diabetic patients with stroke and microalbuminuria [6 patients] had a significant higher vWf level [190.83 +/- 21.07 vs 102.45 +/- 17.8%, p=0.04], low dinesty lipoprotiens [114.67 +/- 35.66 vs 67.64 +/- 13.17 mg/dl, p=0.002] fasting [0.008] and post prandial blood glucose [0.003] compared to 11 microalbuminuric type 2 diabetic patients. Diabetic patients with stroke and microalbuminuria [6 patients] had a significant higher vWf [190.83 +/- 21.07 vs 98.55 +/- 19.6% p=0.027], low dinesty lipoproteins [114.67 +/- 35.66 vs 35.22 +/- 20 mg/dl, p=0.0001], fasting, post prandial blood glucose, cholesterol and triglycerides levels compared to type 2 diabetic patients without stroke or microalbuminuria [9 patients]. Correltion between vWf and other risk factors in type 2 diabetic patients showed a positive correlation to Fasting, posprandial blood glucose, low denidty lipoprotein, microalbuminuria and intima media thickness. The results of this study indicate that among type 2 diabetic patients with MA, those with higher plasma levels of vWf have greater risk of macrovascular disease, so the risk of cerebrovascular stroke among microalbuminuric type 2 diabetic patients is much higher in association with high level of plasma Von Willebrand factor and low denisty lipoprotein than when these factors are absent, and we recommend measurement of plasma Von Willebrand factor in type 2 diabetic patients as a predictor of macrovascular complication . We also recommend mandatory measurement of low density lipoprotein cholesterol level in type 2 diabetic patients to help in prevention of cerebrovascular stroke

Elevated plasma level of von wbllebrand factor and the risk of macrovascular disease in type 2 diabetics with microalbuminuria

Microalbuminuria [MA] is indicative of generalized vascular disease and is related to carotid intima-media thickness [IMT] -which is a marker of macrovascular disease[1]. In this study, we investigated the role of high plasma level of von Mile brand factor [vWJ], as a marker of endothelial dysfunction, in predicting macrovascular disease in type 2 diabetic patients with microalbuminuria. The study group consisted of 30 non- smoking, normotensive type 2 diabetic patients with normal renal function. They were all recruited from the medical outpatient clinic at Kasr El Aini hospital, Cairo University. They were divided into two groups: Group [1]: included 17 [10 male and 7 female] patients with MA[mean age of 56 +/- 8.4, mean diabetes duration 11.6 +/- 3.7 years, mean body mass index " BMI" 30.2 +/- 5.4kg/m[2]], Group[2]: included 13 [5 male and 8 female] patients without MA [mean age 55.5 +/- 8.6years, mean diabetes duration 5.7 +/- 2.6years, mean BMI 29.6 +/- 6.7 kg/m[2]]. Urinary albumin excretion was assessed both qualitatively and quantitatively .Plasma level of vWf was expressed in relative percent [%] as compared to pooled normal plasma. Carotid IMT was evaluated using high resolution B-mode Ultrasonography. Ten age, sex and weight matched normal subjects were included in the study as a control group. Plasma level of vWf was significantly elevated in the study group compared to the control one [182.2 +/- 22.4 vs 85.5 +/- 23.7%, P=0.0001]. Carotid IMT was also significantly higher in type 2 diabetic patients compared to the control group [0.724 +/- 0.421 vs 0.40 +/- 0.06 mm, P=0.0001]. Among the study group, plasma level of vWf was higher in group [1] compared to group [2] [198.5 +/- 23.5 vs 106.0 +/- 20.0%, p=0.001] .Also, carotid IMT was higher in group [1] compared to group [2][0.975 +/- 0.338 vs 0.580 +/- 0.103 mm, p=0.001] .In group [1], there was a positive correlation between plasma level of vWf and fasting blood glucose [r=0.47, p=0.01], post prandial blood glucose [r=0.51, p= 0.01], glycated haemoglobin [r=0.49, p=0.01] .total cholesterol [r= 0.42, p=0.04], triglycerides [r=0.41,p=0.04], MA[r=0.52,p=0.001] and carotid IMT [r=0.61, p=0.0001]. Patients with retinopathy [18 patients] had a significantly higher age, duration of the disease, fasting and post prandial blood glucose, microalbuminuria, intima media thickness [0.8 +/- 0.5 vs 0.2 +/- 0.3mm, P=0.01] and von Willebrand factor [199.8 +/- 2 3.7vs 105.8 +/- 20.65, P=0.04], and a significant lower level of high density lipoprotein[37.055 + 8.814 vs 43.91 +/- 8.106 mg/dl, p= .039], compared to the diabetic group with normal fundi [12 patients].Multiple regression analysis showed that the determinants of carotid IMT in the study group were disease duration [p=0.01], triglycerides [p=0.01], MA[P=0.001], plasma level of vWf [P=0.001] and retinopathy [p=0.01]. The results of this study indicate that among type 2 diabetic patients with MA, those with higher plasma levels of vWf have greater risk of macrovascular disease. Analysis of the results also proves that plasma level of vWf is an independent risk factor for macrovascular disease in type 2 diabetic patients. Measurement of plasma level of vWf would be helpful in assessing the risk of macrovascular disease in those patients