Plasminogen activator inhibitor-I and insulin resistance in coronary heart disease male patients with and without type 2 diabetes mellitus

ABSTRACT

Features and prognosis of coronary heart disease [CHD] differ between diabetics and nondiabetics. This work aimed to study plasminogen activator inhibitor-l [PAl-1] antigen as a fibrinolytic marker, insulin resistance and lipid profile in type 2 diabetic and nondiabetic male patients with CHD, in an attempt to find an explanation-in part-why type 2 diabetics have a less favorable prognosis than the nondiabetics as regard CHD. Sixty male patients with CHD were selected; their age range was 50-60 years. 30 patients were with type 2 diabetes mellitus [DM] [group I] and 30 patients were non-diabetics [group II]. In addition to 15 matched healthy volunteers [control group]. Compared with the controls, diabetic group showed significant higher fasting glucose and insulin levels, insulin resistance [by homeostatic model assessment HOMA], systolic and diastolic blood pressure levels, total cholesterol, triglycerides, low density lipoprotein-cholesterol [LDL-C] and PAI-1; this is in addition to significant lower level of high density lipoprotein-cholesterol [HDL-C]. On comparing the nondiabetic group with the controls, there were similar pattern of changes. On comparing the diabetic and the nondiabetic groups, there were significant increases of systolic blood pressure, total cholesterol, triglycerides;LDL-C, PAl-1, and HOMA index. Both diastolic blood pressure and HDL-C showed non-significant changes. In both the diabetic and nondiabetic groups, PAI-1 showed positive correlations with systolic and diastolic blood pressures, HOMA index, total cholesterol, triglycerides and LDL-C; while HDL-C showed negative correlation. In both the diabetic and nondiabetic groups, HOMA showed positive correlations with total cholesterol, triglycerides, LDL-C and PAI-1; while it was negatively correlated with HDL-C. It was noted that CHD male patients whether with or without type 2 DM were dyslipidemic, with high readings of blood pressure, insulin resistant and had high level of PAl-1. However, CHD patients with type 2 DM had higher degree of disturbances of these coronary risk factors than the nondiabetic patients with CHD. Insulin resistance appeared to be important in such disturbances. In addition, there were complex relationships among the few studied CHD risk factors. This was noted in both studied groups. Finally, it can be concluded from this study that the less favorable prognosis of male patients with type 2 DM and CHD appeared to be -in part-to the heavier burden of the atherothrombotic risk factors of higher blood pressure, dyslipidemia, insulin resistance and abnormal fibrinolysis than the nondiabetic patients. We recommend reduction of insulin resistance in the male diabetic and nondiabetic patients with CHD to reduce the tendency to develop thromboses, hence reducing risk of CHD events