Study of some fibrinolytic parameters in diabetics with and without vascular complications

Aim: Hypofibrinolysis is a common finding in patients with diabetes and a risk factor for the occurrence of micro- and macroangiopathy. Type 2 diabetic patients have a high incidence of atherosclerosis and thrombosis leading to increased morbidity and mortality from coronary artery disease, cerebrovascular disease and peripheral vascular disease. The superimposition of thrombosis or atherosclerosis is associated with hypercoagulation, hypofibrinolysis and/or platelet alteration, which is caused by several factors including endothelial dysfunction, disturbed lipid metabolism, monocyte invasion and smooth muscle proliferation. The aim of the present work was to study the level of plasminogen activator inhibitor-1 [PAI-1] and D-dimer in diabetic patients with vascular complications and to compare these results with a group of diabetic patients without vascular complications. Subjects and The study was carried out on 60 female subjects; 20 healthy normal controls, 20 type 2 diabetic subjects without vascular complications and 20 type 2 diabetics with vascular complications, subdivided into 10 subjects with diabetic proliferate retinopathy as a microvascular complication and 10 subjects with coronary heart disease as a macrovascular complication. The results showed that PAI-1 and D-dimer were higher in type 2 diabetic patients as compared to the control group. Diabetic subjects with vascular complications showed higher level of PAI-1 and D-dimer as compared to those without vascular complications. The euglobulin clot lysis time [ECLT] was prolonged in type 2 diabetics in comparison to the controls. The diabetic patients with vascular complications showed also prolongation of ECLT as compared to those without vascular complications Conclusions: There is a generalized hypercoagulable state in diabetics with vascular complications and this state may play a significant role in the pathogenesis of vascular complications Therefore, good glycemic and lipid control may decrease the level of PAI-1, D-dimer and clot lysis time, so it may delay or prevent the vascular-complications of diabetes

Homocysteine and vascular events in lupus patients with and without raynaud's phenomenon

Aim: Homocysteine [Hcy] is now considered as an independent risk factor for cardiovascular diseases lupus patients with Raynaud's and without Raynaud's phenomenon [RP] are candidates for multiple vascular events due to several contributing factors. Hyperhomoysteinemia is among these factors. Subjects and The aim of this study is to examine the level of fasting homocysteine and anti-cardiolipin antibodies in a selected group of lupus patients with and without Raynaud's phenomenon, and find their relation to some vascular events. No significant difference in the serum levels of ESR, CRP, serum creatinine, anti-ds-DNA, C3, parameters of lipid profile, and the two isotypes of anticardiolipins [aCL] [IgG and IgM], when lupus patients with RP are compared with those with no RP. Homocysteine is significantly elevated in all lupus patients when compared to the control group, yet, there is no difference when lupus patients with RP are compared to those without RP. Conclusions: Our data do not support a cause and effect relationship between homocysteine and Raynaud's phenomon in lupus patients. Also, we are in favour of an essential role for lupus disease itself in the development of hyperhomocysteinemia. Whether nutritional supplementation with folic acid and vitamin B12 is advisable to ameliorate the vasomotor dysregulation in lupus patients with RP is still a matter of debate

Homocysteine in diabetic patients with and without macrovascular complications

Small and large vessel disease is characteristic of the diabetic state. The excess mortality of the patients with type 1 and type 2 diabetes is mainly due to cardiovascular disease and is not adequately explained by conventional cardiovascular risk factors. Homocysteine [Hcy] is a sulphur-containing amino acid formed during the metabolism of dietary methionine. Adequate concentrations of folic acid, vitamins B12 and B6 are essential for the metabolism and dispersal of Hcy. Recently, mild elevations of plasma Hcy have been identified as an independent risk factor for early atherosclerotic vascular disease. The aim of this work was to measure the plasma level of Hcy in diabetic patients with and without macrovascular complications. Subjects and We studied 60 diabetic patients [30 with macrovascular complications and 30 without macrovascular complications] together with 30 healthy subjects as controls. For each patient and control we did history taking, clinical examination and laboratory investigations including glycemic parameters, lipid profile, Hcy, folic acid, vitamin B12 measurement and evaluation for macrovascular complications. We found that Hcy level was significantly higher in diabetic with macrovascular complications than those without and than controls. Also, Hcy level was positively correlated with the number of complications and lipid profile, but negatively correlated with vitamin B12 and folic acid concentration [P<0.005]. Conclusions: Homocysteine is an important risk factor for macrovascular complications of diabetes