Is Lipid Accumulation Product Associated with an Atherogenic Lipoprotein Profile in Brazilian Subjects? / O Produto de Acumulação Lipídica está Associado a um Perfil Aterogênico de Lipoproteínas em Indivíduos Brasileiros?

Abstract Background: Lipid accumulation product (LAP), a simple and low-cost tool, is a novel biomarker of central lipid accumulation and represents a potential surrogate marker for atherogenic lipoprotein profile. However, its association with lipoprotein subfractions has not been described in the literature. Objective: To determine whether LAP index could be used as a marker of low- and high-density lipoprotein (LDL and HDL) size in Brazilian individuals. Methods: This cross-sectional study included patients (n = 351) of both sexes and age between 30-74 years. Clinical and sociodemographic data and family history of diseases were evaluated. Lipoprotein size, and levels of total cholesterol (TC), lipoproteins, apolipoprotein AI and B (APO AI/APO B), glucose, insulin, insulin resistance index (HOMA-IR) and non-esterified fatty acids (NEFA) were assessed in blood samples. LAP was calculated by the formulas [(waist circumference[cm]-58) × (triglycerides[mmol/L]) for women and (waist circumference [cm]-65) × (triglycerides [mmol/L]) for men]. The association between LAP and metabolic parameters were tested by linear trend (general linear model, GLM test) before and after multiple adjustments for potential confounders (sex, age, smoking, statin, fibrate, and hypoglycemic drugs) at significant level p < 0.05. Results: LAP was positively associated with TC, APO B, NEFA, glucose, insulin and HOMA-IR values, and negatively associated with HDL-C. Higher central lipid accumulation was corelated with higher percentage of intermediate HDL and of small LDL and HDL and less amount of large HDL. LDL size was also reduced in greater LAP index values. The negative impact of LAP was maintained after adjustment for multiple variables. Conclusion: LAP was robustly associated with atherogenic profile of lipoprotein subfractions, independently of multiple confounders.

Resumo Fundamento: O produto de acumulação lipídica (LAP), um instrumento simples e de baixo custo, é um novo biomarcador de acúmulo de gordura central e representa um marcador substituto potencial para o perfil aterogênico de lipoproteínas. No entanto, sua associação com subfrações de lipoproteínas ainda não foi descrita na literatura. Objetivo: Determinar se o LAP pode ser usado como um marcador de tamanho da lipoproteína de baixa densidade (LDL) e de alta densidade (HDL) em indivíduos brasileiros. Métodos: Este estudo transversal incluiu 351 pacientes de ambos os sexos e idade entre 30 e 74 anos. Dados clínicos e sociodemográficos e história familiar de doenças foram avaliados. O tamanho das lipoproteínas, e níveis de colesterol total (CT), lipoproteínas, apolipoproteína AI e B (APO AI/APO B), glicose, ácidos graxos não esterificados (AGNEs) e insulina, e índice de resistência insulínica (HOMA-IR) foram avaliados em amostras de sangue. O LAP foi calculado utilizando-se as fórmulas (circunferência da cintura (cm]-58) × (triglicerídeos[mmol/L]) para mulheres e (circunferência da cintura[cm]-65) × (triglicerídeos [mmol/L]) para homens. Associações entre LAP e parâmetros metabólicos foram testadas por tendência linear (modelo linear generalizado, GLM) antes e após ajustes por fatores de confusão (sexo, idade, tabagismo, uso de estatinas, fibratos e hipoglicemiantes) ao nível de significância de p < 0,05). Resultados: LAP apresentou uma associação positiva com CT, APO B, AGNEs, glicose, insulina, HOMA-IR, e uma associação negativa com HDL-C. Maior acúmulo de gordura central correlacionou-se com maior porcentagem de HDL intermediária e de partículas pequenas de LDL e HDL, e menor porcentagem de HDL grande. O tamanho da LDL também era reduzido em valores de LAP mais elevados. O impacto negativo do LAP foi mantido após ajuste para múltiplas variáveis. Conclusão: o LAP esteve fortemente associado com o perfil aterogênico de subfrações de lipoproteínas, independetemente dos fatores de confusão.

Circulating early biomarkers of atherogenesis in participants of the Longitudinal Study of Adult Health (ELSA-Brasil) without diabetes or cardiovascular disease

ABSTRACT Objective Our aim was to describe the distribution of selected biomarkers according to age and sex, adjusted for HOMA-IR and adiposity, in a subset of middle-aged individuals of Brazilian Longitudinal Study of Adult Health-ELSA without diabetes mellitus or CVD. Subjects and methods This cross-sectional study was conducted in 998 participants of the ELSA-Brasil without diabetes and/or cardiovascular disease. In addition to the traditional risk factors, several biomarkers concentrations were compared according to sex, age groups (35-44; 45-54 yrs) and HOMA-IR tertiles. Linear regression was used to examine independent associations of sex and age with selected novel biomarkers, adjusted for body adiposity and HOMA-IR. Results Fifty-five percent were women. Men had higher mean values of body mass index, waist circumference, blood pressure, plasma glucose, HOMA-IR, worse lipid profile and higher E-selectin and lower leptin concentrations than women; while women had higher levels of HDL-cholesterol and leptin than men. Mean values of waist circumference, systolic BP, plasma glucose and apolipoprotein B (Apo B) increased with age in both sexes. Leptin and E-selectin concentrations increased across HOMA-IR tertiles. Independent associations of Apo B with age were found only in male sex, while of leptin with body mass index and HOMA-IR, and of E-selectin with HOMA-IR in both sexes. Conclusions In conclusion, our data indicate age, sex, adiposity and, consequently, insulin resistance, influence circulating levels of Apo B, leptin and E-selectin, suggesting that those aspects should be taken into consideration when assessing these parameters for research or clinical purposes in individuals at relatively low cardiometabolic risk.

Association between LDL-C, Non HDL-C, and Apolipoprotein B Levels with Coronary Plaque Regression / Associação entre Níveis De LDL-C, Não-HDL-C E Apolipoproteína B com Regressão de Placa Coronariana

Previous reports have inferred a linear relationship between LDL-C and changes in coronary plaque volume (CPV) measured by intravascular ultrasound. However, these publications included a small number of studies and did not explore other lipid markers.

Estudos prévios sugerem uma relação linear entre o LDL-C e mudanças no volume de placa coronariana (VPC) medido por ultrassonografia intravascular. No entanto, estas publicações incluíram um número pequeno de estudos e não exploraram outros marcadores lipídicos.

Índices Lipídicos Tetravalente (LTI) e Pentavalente (LPI) em indivíduos saudáveis / Lipid Tetrad Index (LTI) and Lipid Pentad Index (LPI) in healthy subjects

FUNDAMENTO: A prevalência das doenças cardiovasculares (DCV) tem aumentado nos últimos anos. A literatura revela que cerca de 35% dos eventos ateroscleróticos ocorrem na ausência dos fatores de risco clássicos, requerendo uma avaliação individual minuciosa para melhor caracterizar o risco. Os índices lipídicos tetravalente (LTI) e pentavalente (LPI) constituem uma nova e eficiente forma de avaliação do perfil lipídico e do risco para DCV. OBJETIVO: O presente estudo avaliou o LTI e o LPI em estudantes de graduação, estabelecendo estes índices em indivíduos saudáveis e correlacionando-os com o perfil lipídico tradicional. MÉTODOS: Participaram do estudo 110 estudantes, 48 (44%) do sexo masculino e 62 (56%) do sexo feminino, com média de idade de 20,9 ± 1,7 anos. Apolipoproteína-AI, apolipoproteína B, colesterol total, lipoproteína (a), triglicérides, HDL e LDL foram analisados usando-se métodos diagnósticos específicos. LTI e LPI foram calculados por meio das equações LTI = [colesterol total x triglicérides x lipoproteína (a) / HDL] e LPI = [colesterol total x triglicérides x lipoproteína (a) x apolipoproteína B / apolipoproteína A-I], respectivamente. RESULTADOS: Os valores de LTI e de LPI foram significativamente maiores nas mulheres quando comparados aos dos homens. Para os outros parâmetros, houve diferenças significativas entre os gêneros apenas para colesterol total, HDL e apolipoproteína A-I. Houve correlações positivas e significativas entre LDL e LTI e entre LDL e LPI. CONCLUSÃO: Os achados indicam que LTI e LPI estavam associados com LDL, um parâmetro não utilizado para calcular os índices lipídicos e amplamente usado na prática clínica para investigação do risco cardiovascular.

BACKGROUND: The prevalence of cardiovascular disease (CVD) has increased steadily in recent years. Literature data show that about 35% of atherosclerotic events occur in the absence of classic risk factors, requiring a broader assessment of the individual to better characterize the risk. Lipid Tetrad Index (LTI) and Lipid Pentad Index (LPI) constitute a new and efficient evaluation of the lipid profile and CVD risk. OBJECTIVE: This study assessed LTI and LPI in undergraduate students, seeking to establish the parameters of these indices in healthy subjects and correlate them with the conventional lipid profile. METHODS: The study included 110 students, 48 (44%) males and 62 (56%) females, mean age 20.9 ± 1.7. Apolipoprotein-AI, apolipoprotein B, total cholesterol, lipoprotein(a), triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were assessed, using specific diagnostic methods. LTI and LPI indices were calculated using the equations LTI = [total cholesterol x triglycerides x lipoprotein(a) / HDL] and LPI = [total cholesterol x triglycerides x lipoprotein(a) x apolipoprotein B/apolipoprotein-AI], respectively. RESULTS: LTI and LPI values were significantly higher in females compared to males. As for the other parameters, there were significant differences between males and females only regarding total cholesterol, HDL and apolipoprotein-AI. There were significant and positive correlations between LDL and LTI and between LDL and LPI. CONCLUSIONS: Findings indicate that both LTI and LPI were associated with LDL, a parameter not used to calculate lipid indices and widely used in clinical practice for cardiovascular risk assessment.

Association of Apolipoprotein B/Apolipoprotein A1 Ratio and Coronary Artery Stenosis and Plaques Detected by Multi-Detector Computed Tomography in Healthy Population

Despite the noninvasiveness and accuracy of multidetector computed tomography (MDCT), its use as a routine screening tool for occult coronary atherosclerosis is unclear. We investigated whether the ratio of apolipoprotein B (apoB) to apolipoprotein A1 (apoA1), an indicator of the balance between atherogenic and atheroprotective cholesterol transport could predict occult coronary atherosclerosis detected by MDCT. We collected the data of 1,401 subjects (877 men and 524 women) who participated in a routine health screening examination of Asan Medical Center. Significant coronary artery stenosis defined as > 50% stenosis was detected in 114 subjects (8.1%). An increase in apoB/A1 quartiles was associated with increased percentages of subjects with significant coronary stenosis and noncalcified plaques (NCAP). After adjustment for confounding variables, each 0.1 increase in serum apoB/A1 was significantly associated with increased odds ratios (ORs) for coronary stenosis and NCAP of 1.23 and 1.18, respectively. The optimal apoB/A1 ratio cut off value for MDCT detection of significant coronary stenosis was 0.58, which had a sensitivity of 70.2% and a specificity of 48.2% (area under the curve, 0.61; 95% CI, 0.58-0.63, P < 0.001). Our results indicate that apoB/A1 ratio is a good indicator of occult coronary atherosclerosis detected by coronary MDCT.

Relationship between depression and apolipoproteins A and B: a case-control study

OBJECTIVE: To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease. INTRODUCTION: Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein. METHODS: This case-control study included 153 patients with major depressive disorder who fulfilled the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and 147 healthy individuals. All participants completed a demographic questionnaire and Hamilton rating scale for depression. Anthropometric characteristics were recorded. Blood samples were taken and total cholesterol, high-and low-density lipoproteins and apolipoproteins A and B were measured. To analyze the data, t-test, χ2 test, Pearson correlation test and linear regression were applied. RESULTS: Depression was a negative predictor of apolipoprotein A (β = -0.328, p<0.01) and positive predictor of apolipoprotein B (β = 0.290, p<0.05). Apolipoprotein A was inversely predicted by total cholesterol (β = -0.269, p<0.05) and positively predicted by high-density lipoprotein (β = 0.401, p<0.01). Also, low-density lipoprotein was a predictor of apolipoprotein B (β = 0.340, p<0.01). The severity of depression was correlated with the increment in serum apolipoprotein B levels and the decrement in serum apolipoprotein A level. CONCLUSION: In view of the relationship between apolipoproteins A and B and depression, it would seem that screening of these metabolic risk factors besides psychological interventions is necessary in depressed patients.

[Presence of the x+ allele in apolipoprotein b gene increase the total cholesterol and apolipoprotein b concentration in Tehranian people]

Lipid level variations are among the most important risk factors for cardiovascular disease. Apolipoproteins play a the key role in lipid metabolism. In the present study the association of XbaI apolipoprotein B polymorphisms on lipid variation was examined. A cross-sectional study was conducted on 849 subjects from the Tehran Lipid and Glucose Study population. Blood pressure was measured and the body mass index was calculated. TG, Chol, FBS, HDL-C and its subfractions, Apo B and Apo A1 levels were measured, and LDL-C concentration was calculated. A segment of the apo B gene was amplified by PCR and the polymorphism was revealed by RFLP using XbaI restriction enzyme. Allele frequencies obtained for X+ and X- were 27.6% and 72.4%, respectively and were in the Hardy-Weinberg Equilibrium [HWE]. The presence of the X+ allele was significantly associated with increased total cholesterol [X+X+: 193 +/- 1.2 mg/ml vs. X-X-: 182 +/- 1.2 mg/ml, P 0.022] and apolipoprotein B [X+X+: 116 +/- 1.5 mg/ml vs. X-X-: 104 +/- 1.4 mg/ml, P 0.024]. The associations were significant even after adjustment for age, sex, BMI, smoking, diastolic and systolic blood pressure and fasting blood sugar. The observed allele frequencies were similar to other studies. Considering the association of XbaI polymorphisms with lipids factors, it is important to examine the relationship of Apo B gene variation and similar gene with lipids metabolisms

Apolipoprotein B is Highly Associated with the Risk of Coronary Heart Disease as Estimated by the Framingham Risk Score in Healthy Korean Men

The aim of this study was to examine the association between serum apolipoprotein B (apoB) and the risk of coronary heart disease (CHD) using Framingham risk score (FRS) in healthy Korean men. A total of 13,523 men without medication history of diabetes and hypertension were enrolled in this study. The FRS is based on six coronary risk factors. FRS > or = 10% was defined as more-than-a-moderate risk group and FRS > or = 20% as high risk group, respectively. The logistic regression analyses were conducted. When quartile 1 (Q1) set as a reference, in unadjusted analyses, the Q2, Q3, Q4 of apoB level had increased odds ratio (OR) for the risk of CHD in both more-than-a-moderate risk and high risk group, respectively. After adjusting for confounding variables, multivariable-adjusted logistic regression analyses showed a strong relationship between the quartiles of apoB level and more-than-a-moderate risk and high risk group, respectively. These associations were attenuated, but still remained statistically significant. ApoB is found to be independently related to the risk of CHD using FRS in healthy Korean men, and the link between apoB and the risk of CHD is dose-depedent.

Coronary heart disease in Indians: Implications of the INTERHEART study.

Coronary heart diseases (CHD) have reached epidemic proportions among Indians. The recently concluded INTWERHEART study emphasizes the role of behavioural and conventional risk factors in the prediction of CHD risk among Indians. These findings have implication for the health care providers and policy makers in the country due to the fact that all these conventional risk factors are potentially modifiable and are good starting points for prevention. The policy measures by means of legislation and regulatory approaches on agriculture and food industry or tobacco or physical activity will have large impact on CHD risk factor reduction in the population. In addition, the health system needs to focus on: (i) providing information for increasing awareness and an enabling environment for adoption of healthy living habits by the community; (ii) early detection of persons with risk factors and cost-effective interventions for reducing risk; and (iii) early detection of persons with clinical disease and cost-effective secondary prevention measures to prevent complications. The evidence from INTERHEART provides rationale for developing treatment algorithms and treatment guidelines for CHD at various levels of health care. In addition, INTERHEART provides answer for the quest for a single reliable biomarker, Apo B/ApoA 1 ratio that can predict the future CHD risk among individuals. Further to this, the INTERHEART study also opens up several unanswered questions on the pathobiology of the premature onset of myocardial infarction among Indians and calls for the need to developing capacity in clinical research in CHD in India.

[Comparison of non-HDL cholestrol level with LDL, cholesterol and other lipids markers level regarding investigation of lipoproteins disorder in hospitalizedpatients in Mazandran Heart Hospital]

Considering some restrictions of serum low density lipoprotein [LDL] as a marker for Coronary Artery Disease [CAD] risk factor and also the importance of apo B as a signinificant risk factor for CAD, measurement of non-HDL cholesterol has great value as a risk factor for CAD. Non-HDL cholesterol [total cholesterol minus HDL cholesterol] contains all lipoproteins including apo-lipoproteins. In this study, 200 hospitalized patients [100 men and 100 women] with the diagnosis of CAD, documented by coronary angiography and 100 persons with normal angiography were recruited as case and control groups, respectively. Non-HDL cholesterol non-HDL-c was compared with LDL- cholesterol as a risk factor for CAD. Measured levels of triglyceride, total cholesterol, lipoprotein atherogenic a [Lpa] and non-HDL-c were significantly higher than those in control group. HDL level was lower in patients group. Correlation analysis showed that non-HDL-c [and not LDL cholesterol] had a higher reverse correlation triglyceride level. Measurement of non-HDL-c could be a good marker in atherogenic lipoproteins. Furthermore, due to potential power of its other atherogenic lipoproteins, it cannot be measured by LDL alone

Effects of conjugated linoleic acid on serum Apo B and MDA in type II diabetic patients

Some animal studies have suggested that Conjugated Linoleic acid [CLA] supplementation may have therapeutic potential with respect to lipid metabolism, considered to be the most important cardiovascular disease [CVD] related risk factor, associated with type 2 diabetes mellitus [T2DM]. However, results from human studies on risk markers of diabetes are ambiguous. This study was carried out to determine the effect of CLA supplementation [as 50:50 proportions of c9, t11 and t10, c12 CLA isomers] on serum lipid profiles, MDA, apo-B100, systolic and diastolic blood pressures in patients with T2DM. The study was a randomized double-blind, placebo-controlled parallel intervention. Participants were 39 T2DM patients [35 to 50 y, 30>BMI >25] stratified, according to sex, age and BMI into two groups. The intervention group took 3.0 g CLA/d [3x1 g, capsules], a 50:50 isomer blend of c9, t11 and t10, c12 CLA] while the control group took soy bean oil as CLA placebo for 8 weeks. Blood pressure, serum lipid profile, MDA, and Apo B were measured at baseline and at the end of the intervention. There were no significant differences in serum triacylglycerol, total cholesterol, LDL-C, HDL-C, apo-B100 and MDA between the two groups after week 8; nor were any significant differences observed in systolic and diastolic blood pressure between the two groups after intervention. Results of this study suggest that short term CLA supplementation [3g/d] may not improve lipid profiles, apo-B100 and MDA concentrations in T2DM patients

Gall stones in non-alcoholic fatty liver disease and its relation to insulin resistance and apolipoprotein-B

Data suggest that hyperinsulinemia is a risk factor for both gall stones and non-alcoholic fatty liver disease [NAFLD]. Was to evaluate the relation of insulin resistance and serum Apolipoprotein-B with gall stone disease [GD] in patients with non-alcoholic fatty liver disease [NAFLD]. A total of 60 patients with NAFLD were included in the study and diagnosed with ultrasonography in the absence of known aetiologies of liver diseases. They were classified into two groups; 40 patients with gall stones and 20 without gall stones. Insulin resistance, BMI and biochemical markers were compared. Insulin resistance [HOMA-IR >2] was found in 16 patients of group I and 6 patients in group II. On comparing both study groups, the difference was statistically non-significant [1.99 +/- 1.07 Vs 1.64 +/- 1.16, p >0.05]. S. uric acid was significantly higher in group I than group II [6.71 +/- 1.91 vs. 5.33 +/- 1.57, P <0.05]. Also, S. uric acid was higher in male patients of group I than males in group II [7.77 +/- 1.63 vs. 5.96 +/- 0.34, P <0.05]. In our study, fasting insulin was higher in females of group I than females in group II [7.55 +/- 3.74 vs. 3.84 +/- 0.88, P <0.05]. It was found that there was no statistically significant association between serum Apolipoprotein-B and HOMA-IR in the overall series [1.58+7-171.17 in HOMA-IR<2 Vs 134.77+7-46.06 in HOMA-IR>2, p >0.05] and in each of the study groups. At stepwise regression analysis, it was found that serum uric acid was associated with gall stone disease in the overall series and in men. Also stepwise regression analysis indicated that fasting insulin, s. uric acid, fasting glucose, fasting triglycerides and BMI were important factors associated with gall stone disease in all our study's female patients. The association of HOMA-IR with gall stones disease in NAFLD is controversial as no statistically significant difference was found regarding HOMA-IR on comparing NAFLD patients with to those without gall stones. S. uric acid is a risk factor and associated with gall stone disease in men with NAFLD. Fasting serum insulin, serum triglycerides and BMI are important risk factors associated with gall stone disease in women with NAFLD

Niveles séricos de Apo-AI y Apo-B como indicadores de estenosis de injerto sintético después de bypass arterial en enfermedad arterial periférica / Serum levels of Apo-AI and B as markers of synthetic graft stenosis after bypass for peripheral artery disease

BACKGROUND: Hyperlipidemias are the main risk factors for atherosclerosis and cardiovascular disease. Nevertheless, the protein fractions of these lipids such as apolipoprotein B (Apo-B) can lead to arterial obstruction. In this study we investigated levels of apolipoproteins AI and B in patients with chronic occlusive peripheral arterial disease (PAD) of the lower extremities and their association with either patency or stenosis of synthetic grafts. METHODS: This cohort study included 24 patients with chronic occlusive PAD who underwent infrainguinal revascularization with polytetrafluoroethylene (PTFE) synthetic graft. Patients were divided into two groups according to whether or not they were exposed to Apo-B, thus integrating two cohorts: the unexposed group (group 1, normal levels of Apo-B) and the exposed group (group 2, high levels of Apo-B). Variables investigated at 3, 6 and 12 months included arm/ankle index (AAI) and its association with levels of Apo-AI and Apo-B, and levels of cholesterol, triglycerides, and fibrinogen. RESULTS: The study was comprised of 67% men and 33% women. Average age was 65.2 +/- 8.4 years. There was a correlation between AAI and high levels of Apo-B (p <0.001). Apo-AI levels were not significantly different between groups. Fibrinogen remained elevated in both groups with no statistical difference. Triglycerides demonstrated a significant difference between groups in basal measurements (p <0.05). Cholesterol remained normal in both groups without statistical difference. CONCLUSIONS: This study demonstrates that patients exposed to high levels of Apo-B had synthetic graft failure (obstruction), as demonstrated by AAI <1.

Biochemical markers and lipoprotein profile levels in childhood type I diabetes mellitus: early prediction of vascular complications

Diabetes mellitus is the most common endocrine and metabolic disorder in childhood and adolescents, with no cure. In this work, we studied the serum levels of the soluble leucocyte adhesion molecules, vascular adhesion molecules -1 [sVCAM-1], intercellular adhesion molecules -1 [Svcam-1], intercellular adhesion molecules [sICAM-1, sICAM-2], and sE-selectin. Also, we studied the lipoprotein phenotype including: serum triglyceride, serum cholesterol, HDL. VLDL, LDL, apoA, and apoB in the serum of 27 children [13 male 14 female] with type 1 diabetes mellitus with and without vascular complications. Their ages ranged from [2.25-20 years] with a mean 15.6 +/- 5.2 years. They were divided into two groups, group [Ia]comprised 14 patients without vascular complications and group [Ib], 13 patients with vascular complications [microalbuminuria, neuropathy, hypertension and retinopahy] presenting with vaying degrees of metabolic control and disease duration and were compared with age, sex matched healthy subjects [n=22, 10 male, 12 female] mean age 14.9 +/- 4.8 yeas. There were significantly higher concentration of soluble sVCAM-1 [mean 1866.7 +/- 631.6ng/mL], sICAM-1 [mean 581.6 +/- 387.1ng/mL], sICAM-2 [mean 425.1 +/- 215.6ng/mL] in type 1 diabetic patients versus age, sex matched control [mean 947.3 +/- 469.6. 184.8 +/- 62.3, and 193.1 +/- 66.6 ng/mL] respectively, p<0.001. As regards sE-selectin there was no significant differences in the concentration in both diabetic and control groups. Significant positive correlations were found between [sICAM-1, sICAM-2] and HbAlc [r=0.44, r=0.37] respectively p<0.05, but no correlations were found between sVCAM-1 or sE selectin and glycosylated hemoglobin. There was a significant increase in sVCAM-1 serum of diabetic children with vascular complications as compared to diabetic children without vascular complications [mean 2183.6 +/- 600.3 versus 1590.4 +/- 584.2ng/mL] [p<0.05]. In diabetic children with positive microalbuminuria there were significant higher levels of sVCAM-1 concentration when compared with the normoalbuminuric diabetic patients [mean 2343.2 +/- 572.7 versus 1709.4 +/- 576.7 ng/mL] p<0.05. While no significant difference were found in the levels of sICAM-1, sICAM-2 and sE-selectin between both groups of diabetic children with and without vasacular complications. As regard lipid profile there were significant increase in serum triglycerides [mean 140.6 +/- 40.9, p<0.01], serum cholesterol [mean 190.6 +/- 25.7, p<0.001], VLDL [mean 26.2 +/- 7.9, p<0.05], LDL [mean 121.8 +/- 29.6 p<0.001], apoA [mean 208.1 +/- 47.4, p<0.001 and apoB [mean 175.9 +/- 54.8, p<0.001] in diabetic patients as compared with control group [mean 100.7 +/- 32.5, 152.5 +/- 26.7, 20.1 +/- 6.5, 78.7 +/- 29.9, 148.5 +/- 42.9 and 84.53 +/- 33.2] respectively. There was a decrease in HDL in diabetic patients as compared to control group but it was not statistically significant. Correlations between circulating adhesion molecules and lipid profile revealed that there was a significant correlations between sVCAM-1 and serum triglyceride, serum cholesterol, HDL. LDL in diabetic children with vascular complications [r=0.56, r=0.53 p<0.01, r=0.43, r=0.46 p<0.05] respectively. In diabetic children without complication there was a significant correlation between sVCAM-1 and cholesterol. VLDL [r=0.37, r=0.39 respectively p<0.05]. Also, there was a significant positive correlation between sICAM-1 and VLDL [r=0.46, p<0.05], and there was a significant correlation between sICAM-2 and LDL [r=0.37, p<0.05] in diabetic children with vascular complications. But there was no significant correlation between sVCAM-1 and sICAM-1, sICAM-2 and sE-sellectin levels in both groups of diabetic patients and their age, disease duration, mean blood glucose, insulin dose, or frequency of diabetic ketoacidosis or hypoglycemic attack which reflect extreme variation in the glycemic control. In patient with microalbujminuria, there was a significant positive correlation between sVCAM-1 and serum triglycerides, serum cholesterol, LDL [r=0.45, p<0.05, r=0.48 p<0.01, r=0.37 p<0.05] respectively. Also a significant positive correlation was found between intercellular adhesion molecules sICAM-2 and LDL [r=0.39, p<0.05]. sICAM-1 has a positive correlation with triglyceride [r=0.39, p<0.05] and a significant negative correlation with HDL [r=0.4, p<0.05], was identified as well. We concluded that in respective of actual metabolic control, serum concentration of sVCAM-1 sICAM-1 and sICAM-2 but not sE-selection are elevated in patients with type I diabetes mellitus, reflecting ongoing endothelial cell stimulation and leucocyte activation even in the absence of clinically detectable angiopathy. Our results suggest an important role of sVCAM-1 in micro and macrovascular complications which may serve as the basic for further evaluation of circulating sVCAM-1 as a potential serum marker for vascular complications. Also sICAM-1, sICAM-2, seem to be good and reliable indicators of glycemic control. Our finding proved an important relationship between adhesion molecules and dyslipidemia exists in type 1 diabetic patients with vascular complications. It is recommended to screen diabetic children regularly for sole adhesion molecules, lipid profile and microalbuminurea levels for early detection of diabetic vascular complications

measurement of serum lepoprotein [a] and apolipoprotein-B be of prognostic value in patients with type II diabetes mellitus with myocardial infarction and peripheral vascular disease?

Current clinical guidelines require that five indices [total cholesterol LDL cholesterol, HDL cholesterol triglycerides and the total/ HDL cholesterol ratio] be measured or calculated to assess the lipid related risk of vascular disease. Recently, quantification of plasma Lp [a] and Apo-B was proposed as recent clinical markers that will allow better prediction of coronary and peripheral arterial disease. This study prospectively examined whether high levels of Lp [a] and Apo-B have a significant risk and prognostic value in type II diabetic patients with myocardial infarction and peripheral vascular disease. The patients included in the study were selected properly from outpatient clinics of Vascular Surgery Unit as well as Internal Medicine Department [Cardiovascular Unit], Mansoura University. The patients were divided into 4 groups: Group I [n=15]: Type II DM with no CAD and no PVD. Group II [n=15]: Type II DM with history of myocardial infarction and No PVD. Group III [n=15]: Type II DM with no history of myocardial infarction but have symptomatic PVD. Group IV [n=15]: Type II DM with history of myocardial infarction and have PVD. Patients with acute illness or taking Niacin, Estrogen replacement or antibiotics were excluded. All patients were subjected to thorough history taking, cardiovascular and peripheral vascular system evaluation including BMI, ABJ, ECG, Doppler echocardiogram as well as peripheral vascular angiography. Laboratory evaluation of our patients include assessment of diabetic state, HbAlc, standard lipid profile parameters as well as evaluation of Lp [a] and Apo-B. Serum level of Lp [a] and Apo-B showed highly statistically significant results when comparing group I with any group of type II diabetic patients complicated with either MI or PVD [P<0.001]. However, serum apo-B level was highly significant in those complicated with PVD [P<0.001], while serum Lp[a] was statistically higher in those having myo-cardial infarction [P=0.03]. Our study revealed that elevation of serum level of both Lp [a] and Apo-B were significantly correlated with occurrence of myocardial infarction and different grades of peripheral vascular insufficiency in type II diabetic individuals. However, increased serum level of Lp[a] showed higher significant prediction for occurrence of MI while, elevation of serum level of Apo-B predict more the occurrence of PVD among our patients. Evaluation of serum Lp [a] and Apo-B levels should be considered a new risk factor and of prognostic value for occurrence of vascular complications in type II diabetic patients. More population-based prospective studies are needed to answer the question definitively of whether Lp [a] and Apo-B leuels are more predictive of CAD and PVD in type II diabetic individuals than the traditional lipid parameters

Can measurement of serum lipoprotein [a] and apolipoprotein-B be of prognostic value in patients with type 2 diabetes mellitus with myocardial infarction and peripheral vascular disease?

Current clinical guidelines require that five indices [total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and the total/HDL cholesterol ratio] be measured or calculated to assess the lipid-related risk of vascular disease. Recently, quantification of plasma Lp[a] and Apo-B was proposed as recent clinical markers that will allow better prediction of coronary and peripheral arterial disease. This study prospectively examined whether high levels of Lp[a] and Apo-B have a significant risk and prognostic value in type 2 diabetic patients with myocardial infarction and peripheral vascular disease. The patients included in the study were selected properly from outpatient clinics of Vascular Surgery Unit as well as Internal Medicine Department [Cardiovascular Unit], Mansoura University. The patients were divided into 4 groups: Group I [n=15]: Type 2 DM with no CAD and no PVD. Group II [n=15]: Type 2 DM with history of myocardial infarction and No PVD. Group Ill [n=15]: Type 2 DM with no history of myocardial infarction but have symptomatic PVD. Group IV [n=15]: Type 2 DM with history of myocardial infarction and have PVD. Patients with acute illness or taking Niacin, Estrogen replacement or antibiotics were excluded. All patients were subjected to thorough history taking, cardiovascular and peripheral vascular system evaluation including BMI, ABI, ECG, Doppler US echocardiogram as well as peripheral vascular angiography. Laboratory evaluation of our patients included assessment of diabetic state, HbA1c, standard lipid profile parameters as well as evaluation of Lp[a] and Apo-B. Serum level of Lp[a] and Apo-B showed highly statistically significant results when comparing group I with any group of type 2 diabetic patients complicated with either MI or PVD [P<0.001]. However, serum apo-B level was highly significant in those complicated with PVD [P<0.001], while serum Lp[a] was statistically higher in those having myocardial infarction [P=0.03]. Our study revealed that elevation of serum level of both Lp[a] and Apo-B were significantly correlated with occurrence of myocardial infarction and different grades of peripheral vascular insufficiency in type 2 diabetic individuals. However, increased serum level of Lp[a] showed higher significant prediction for occurrence of MI while, elevation of serum level of Apo-B predict more the occurrence of PVD among our patients. Evaluation of serum Lp[a] and Apo-B levels should be considered a new risk factor and is of prognostic value for occurrence of vascular complications in type 2 diabetic patients. More population-based prospective studies are needed to answer the question definitively of whether Lp[a] and Apo-B levels are more predictive of CAD and PVD in type 2 diabetic individuals than the traditional lipid parameters

Apolipoprotein B/apolipoprotein A-I ratio in relation to various definitions of metabolic syndrome among Saudi patients with type 2 diabetes mellitus

To assess if the apolipoprotein Apo B/Apo A-I ratio in Saudi patients with type 2 diabetes mellitus T2DM is associated with metabolic syndrome MetS. This cross-sectional study was conducted on 250 patients with T2DM, above 40 years of age, at King Abdulaziz University Hospital Diabetes Center in Riyadh, Saudi Arabia, between January and December 2006. Metabolic syndrome was defined, and compared according to 3 criteria, namely, National Cholesterol Education Program Adult Treatment Panel III, International Diabetes Federation, and World Health Organization. In the 250 patients studied, all 3 definitions demonstrated significant increase in the Apo B/Apo A-I ratio, in Saudi type 2 diabetics with the MetS. There was a strong positive correlation between the Apo B/Apo A-I ratio and triglycerides, low-density lipoprotein cholesterol, and total cholesterol r=0.43-0.54, p<0.0001, and a weak, yet significant, correlation r=0.14-0.21, p<0.05 with waist circumference, waist-hip ratio, fasting glucose, and hemoglobin A1c, however, not with body mass index r=0.01, p=0.88. In contrast, the ratio showed strong negative correlation with high-density lipoprotein cholesterol r = -0.7, p < 0.0001. Apolipoprotein B/apolipoprotein A-I ratio is significantly associated with MetS in Saudi patients with T2DM, similar to observations made in other ethnic groups

Intervalo QT corrigido e fatores de risco tradicionais para doença aterosclerótica em pacientes com diabetes tipo 1 / QTc Interval and traditional risk factors to atherosclerotic disease in patients with type 1 diabetes

Visando avaliar o intervalo QTc e sua relação com variáveis clínicas, laboratoriais e com suscetibilidade da LDL à oxidação in vitro em pacientes com DM1, estudamos 40 diabéticos e 33 não diabéticos com idades de 24,83 ± 10,21 e 23,51 ± 7,28 anos, respectivamente, pareados por sexo, idade e índice de massa corporal (IMC). Avaliamos controle metabólico, apolipoproteínas A e B, coeficiente de oxidação da LDL por espectrofotometria e eletrocardiograma (ECG). O intervalo QTc foi calculado pela fórmula de Bazett. Não houve diferença no QTc entre os grupos dos DM1 e dos não diabéticos (394,43 ± 19,98 ms vs. 401,31 ± 17,83 ms; p = 0,2065). Cinco diabéticos apresentavam QTc aumentado (396,76 ± 14,63 ms vs. 429,75 ± 1,89 ms; p < 0,001) e menores níveis de apolipoproteína A que os demais diabéticos (74,60 ± 25,42 mg/dL vs. 113,64 ± 29,79 mg/dL; p = 0,011). Na amostra total, houve correlação entre QTc e IMC (rho = -0,288; p = 0,045), glicemia pós-prandial (rho = 0,357; p = 0,016) e coeficiente de oxidação 3 h (Cox3h) (r = -0,293; p = 0,039). Nos diabéticos, encontramos correlação entre QTc e triglicerídeos (rho = -0,420; p = 0,023) e Cox3h (r = -0,427; p = 0,021). Embora não tenhamos encontrado diferença entre o QTc dos diabéticos e não diabéticos estudados, houve correlação com marcadores de risco para a doença aterosclerótica. Entretanto, ainda são necessários mais estudos para estabelecer o real valor preditivo do QTc para esta doença nos pacientes com DM1.

To evaluate the QTc interval and its relation with clinical, laboratorial variables and LDL susceptibility to in vitro oxidation in patients with type 1 DM, we studied 40 diabetics and 33 non diabetics with 24.83 ± 10.21 and 23.51 ± 7.28 years old, respectively matched by sex, age and body mass index (BMI). We evaluated metabolic control, A and B apolipoproteins, LDL oxidation coefficient for spectrophotometry and electrocardiogram (ECG). Interval QTc was calculated by the Bazett’s formula. There was no difference in QTc between diabetic and non diabetic groups (394.43 ± 19.98 ms versus 401.31 ± 17.83 ms; p = 0.2065). Five diabetics showed increased QTc (396.76 ± 14.63 ms versus 429.75 ± 1.89 ms; p < 0.001) and lesser A apolipoprotein levels than rest of diabetic group (74.60 ± 25.42 mg/dL versus 113.64 ± 29.79 mg/dL; p = 0,011). In pooled sample, there was correlation between QTc and BMI (rho = -0.288; p = 0.045), pot-prandial glycemia (rho = 0.357; p = 0.016) and 3 h oxidation coefficient (OxC3h) (r = -0.293; p = 0.039). In diabetics, there was correlation between QTc and triglycerides (rho = -0.420; p = 0.023) and OxC3h (r = -0.427; p = 0.021). Although there was no difference between QTc of diabetics and the non diabetics subjects studied, there was correlation with risk factors for the atherosclerotic disease. Further studies are necessary to establish the real predictive value of QTc for this type of disease in the patients with type 1 DM.

Apo B/Apo A-I ratio in central and peripheral arterial diseases

BACKGROUND: The apo B/apo A-I ratio represents the balance between atherogenic particles, rich in apo B, and the antiatherogenic ones, apo A-I rich. This study investigated the association between atherosclerotic diseases in different anatomical sites and apo B/apo A-I ratio. METHODS: Lipids, lipoproteins, and apolipoproteins A-I and B were assessed in 30 subjects with coronary artery disease (CAD), 26 with ischemic stroke (IS), 30 with peripheral arterial obstructive disease (PAOD), and 38 healthy subjects (controls). RESULTS: HDLc and Apo A-I were significantly lower in PAOD and CAD groups, respectively, than in other groups. Significantly higher levels of triglycerides were observed for CAD and PAOD groups than for controls. Apo B was significantly higher in IS group than in control and PAOD groups. The apo B/apo A-I ratio showed significantly higher in CAD and IS groups when compared to control and PAOD groups (p < 0.001). CONCLUSION: The apo B/apo A-I ratio was important for identifying an increased trend for coronary and cerebral atherosclerosis. In spite of the increased trend for apo B/apo A-I ratio in IS and CAD groups, the studied variables cannot be considered in an isolated way, given as those parameters were analyzed together by a binary logistic regression, no association has been demonstrated.

INTRODUÇÃO: O índice apo B/apo A-I representa o balanço entre partículas de colesterol potencialmente aterogênicas ricas em apo B e partículas anti-aterogênicas ricas em apo A-I. O objetivo deste estudo foi investigar a associação entre doenças ateroscleróticas em diferentes sítios anatômicos e o índice apo B/apo A-I. MÉTODOS: Lípides, lipoproteínas e apolipoproteínas A-I e B foram quantificados em 30 indivíduos apresentando doença arterial coronariana (DAC), 26 com acidente vascular cerebral (AVC), 34 apresentando doença arterial obstrutiva periférica (DAOP) e 38 indivíduos hígidos (grupo controle). RESULTADOS: HDLc e apo A-I apresentaram-se significativamente mais baixos nos grupos DAOP e DAC, respectivamente, quando comparados com os demais grupos. Níveis de triglicérides foram significativamente mais elevados nos grupos DAC e PAOD quando comparados com o grupo controle. Apo B foi significativamente mais elevada no grupo AVC quando comparado com os grupos controle e DAOP. O índice apo B/apo A-I se mostrou significativamente elevado nos grupos DAC e AVC quando comparados com os demais (p < 0,001). CONCLUSÃO: O índice apo B/apo A-I foi importante para identificar uma tendência aumentada para aterosclerose coronariana e cerebral. No entanto, os parâmetros avaliados não podem ser considerados de forma isolada, considerando que nenhuma associação foi demonstrada quando os dados foram analisados pelo modelo de regressão logística binária.