RESUMO
Diabetes mellitus imposes a tremendous burden on health economies mainly because of its devastating complications. A long duration of metabolic disturbances can cause vascular damage leading to both macro and micro vascular complications. There is an increasing evidence that atherosclerosis is accompanied by inflammation. Our aim in this study is to prove that a low grade inflammation accompany the diabetes mellitus and this inflammatory process is correlated to diabetic control and diabetic complications. Our study was done on 100 elderly diabetic patients whose total white blood cell count was in the normal range. Their age ranged from 65-85years with mean age of them is 68.1 years, half of them were males and the other half were females. They undergo full clinical examination and laboratory investigations including total white blood cell count, serum Creatine protein level, albumin level in urine. glycosylated haemoglobin in addition to other routine laboratory investigations. The patients were divided into 5 quintiles according to the distribution of the total white blood cell count and serum C-reactive protein level. We found a highly significant positive correlation [P value <0.0001] of the total white blood cell count and serum C-reactive protein level to the diabetes duration, body mass index, systolic and diastolic blood pressure, fasting and post prandial blood glucose levels, glycosylated haemoglobin, total cholesterol, low density lipoprotein-cholesterol, serum creatinine and albuminuria and a highly significant negative Correlation with the high density Iipoprotein-cholesterol [P value<0.0001]. We found also a highly significant positive correlation of the total white blood cell Count and serum C-reactive protein level with diabetic micro and macro vascular complications [P value<0.0001]. Moreover, there is an increased risk of macro and micro vascular complications with progressive quintiles of both white blood cell count and serum C-reactive protein level. The odds ratio for the group 5 of the total white blood cell count in comparison to group 1and2 equals 7.35 [confidence Interval= 3.12-9.31] for macro vascular complications and it equals 7.19 [confidence interval= 4.12-9.19] for micro vascular complications. The odds ratio for groups 3,4and 5 of the serum C-reactive protein level equals 9.31[confidence interval= 6.19-18.1] in comparison to groups 1 and 2 for macro vascular complications and it equals 7.31 [confidence interval= 5.19-15.9] for micro vascular complications. We found also an increased risk for smokers to develop both macro and micro vascular complications of diabetes mellitus , odds ratio equals 6.87[confidence interval= 2.14-22.06] and 3 [confidence interval=1.07-8.38] respectively compared with non smokers in the lowest quintile
RESUMO
Strong epidemiological evidence is available that iron is an important factor in the process of atherosclerosis. Therefore, it has been hypothesized that the assessment of novel markers help to identify persons prone to premature CAD. The aim of the study is to assess the potential role of ferritin as an independent risk factor promoting atherosclerosis. 45 patients with CAD were studied and subdivided into 3 main groups; group 1: patients with chronic., stable angina group 2: patients with unstable angina, group 3: patients with acute myocardial infarction and additional group 4 of 15 subjects as a control. All patients and control were subjected to accurate history taking, clinical examination and a variety of laboratory investigations in association with s. ferritin and plasma malondialdehyde level [MDA]. It was found that patients with CAD whether chronic stable angina, unstable angina, or acute myocardial infarction had a significant higher serum ferritin level than the control subjects: mean s. ferritin: 702.46 +/- 211.36 ng/L versus 195.66 +/- 41.46 ng/L, P-value 0.001 also the CAD patients had a higher oxidative stress represented by lipid proxidation product MDA [Malondialdehyde]: mean MDA in umol/L 0.780 +/- 0.213 versus 0.375+0.198/umol/L for the control subjects, P-value 0.01. Serum ferritin could be considered a novel, and independent CAD risk factor associated with increased oxidative stress in th n of increased lipid peroxidation and hence MDA