RESUMO
Objective: To evaluate the role of Fetuin A levels in predicting glycemic outcome in individuals with impaired fasting glucose. Research Design and Methods: A total of 742 young individuals were recruited for the study out of which 177 had impaired fasting glucose, 468 had normoglycemia and 97 individuals with diabetes. These individuals were offsprings of diabetics (either mother or father or both) and were siblings amongst themselves belonging to age group of 18-35 years. Various biochemical investigations such as fasting plasma glucose, glycosylated Hb, serum insulin, C-peptide and Fetuin A were carried out. People with impaired fasting glucose were followed and analyzed according to glycemic outcome and quartile of Fetuin A level. Results: A total of 66 individuals with prediabetes reverted back to normal, 28 progressed to diabetes and 83 remained with prediabetes over a mean±S.D follow up of 24±4.1 months. People in the highest quartile of fetuin A had the highest Insulin, Insulin Resistance, Increased loss of beta cell activity, decreased sensitivity to insulin and a higher rate of progression to diabetes (relative risk 11.96, 95% CI 5.9 to 24.01, p<0.001) and a significantly lower rate of reversion to normoglycemia (relative risk 5.62, 95% CI 3.16 to 9.9, p<0.001) than those in other Fetuin A quartiles. fetuin A correlated positively with Insulin (r= +0.289, p<0.001), C-peptide (r=+ 0.177, p<0.001), %β cell function(r= -0.368, p<0.001), insulin resistance (r= +0.436, p<0.001) and glycosylated Hb (r=+0.958, p<0.05) and negatively with % sensitivity to insulin( r= -0.287, p<0.001). Cox regression analysis showed that baseline fetuin A, insulin levels and fasting glucose levels were predictive of reversion to normoglycemia. Conclusions: Increased fetuin A levels had an adverse impact on glycemic outcomes thus suggesting that fasting plasma glucose and Fetuin A can be used as a tool to determine the susceptibility of an individual to develop pre-diabetes and thus diabetes mellitus.
RESUMO
These days apolipoproteins especially apo B and apo A I are thought to be better predictors of risk of coronary artery disease as compared to lipids and lipoprotein cholesterol. Lifestyle modification and use of lipid modifying drugs such as statins and fibrates have proven effective in reducing the risk of coronary artery disease. Statins and fibrates are known to possess anti-atherosclerotic properties in addition to lipid modifying effects. Extensive data is available regarding lipid modification especially lowering of low density lipoprotein-cholesterol levels by these drugs. But the data regarding the effect of statins and fibrates, on apolipoprotein levels is scanty. Hence the present study was aimed at assessing the effect of statins (atorvastatin, simvastatin) and fenofibrate on serum apo B and apo A I levels in addition to their lipid modifying effects in various age groups of coronary artery disease patients. One hundred patients suffering from coronary artery disease were randomly assigned to 10 mg atorvastatin, 10 mg simvastatin and 200 mg fenofibrate, separately (without any combination). All the patients were divided into three age groups; group I (35-45 years), group II (46-55 years) and group III (> 55 years). Significant modification was observed in lipid and lipoprotein profile of coronary artery disease patients when treated with these drugs (statins and fibrates). A significant increase in serum apo A I (p < 0.01) and decline in serum apo B levels (p < 0.01) was observed in case of coronary artery disease patients after 16 weeks treatment, though the effect started after 1 month. All the three drugs reduced serum apo B levels in a comparable manner. Fenofibrate increased serum high density lipoprotein-cholesterol and apo A I levels more as compared to statins. It had nearly, proportionate effect in increasing high density lipoprotein-cholesterol and apo A I levels and reducing serum low density lipoprotein-cholesterol and apo B levels while the effect was disproportionate in case of atorvastatin and simvastatin. All the three drugs not only corrected lipid and lipoprotein cholesterol levels but also modified, apolipoprotein levels in a positive direction in coronary artery disease patients. Advancing age had no appreciable effect on the efficacy of these drugs.