Serum lipids and apolipoproteins and their relationship with macrovascular disease in type 1 diabetes.

In order to examine the relationship between serum lipids and apolipoproteins and macrovascular disease in patients with Type 1 diabetes mellitus, 50 patients with Type 1 diabetes mellitus attending the diabetic clinics at St Mary's and St Charles' Hospitals, London were recruited into a cross-sectional study. B-mode ultrasound was used to measure intima-media thickness and define an arterial ultrasound score for each patient as a non-invasive indicator of atherosclerotic change. Intima-medial (i-m) thickness was significantly higher in those subjects with clinical evidence of macrovascular disease compared to those without macrovascular disease (0.865 +/- 0.191 vs 0.695 +/- 0.162 mm, p = 0.0038). In the study group there were significant correlations between i-m thickness and age (r = 0.65, p < 0.01), total serum cholesterol (r = 0.32, p < 0.01), and serum fibrinogen (r = 0.43, p < 0.01) but no other lipid or apolipoprotein variable. When i-m thickness was corrected for age there were significant correlations with total cholesterol (r = 0.43, p < 0.01) and LDL-cholesterol (r = 0.42, p < 0.01). Whereas total and LDL-cholesterol and serum fibrinogen concentrations were related to the extent of atherosclerotic disease by ultrasound techniques, there was no relationship with high density lipoprotein (HDL) or subfraction cholesterol concentrations. HDL-cholesterol may not be a useful marker for cardiovascular disease in Type 1 diabetes.

The effects of gender and type of diabetes on HDL-cholesterol.

OBJECTIVE: To investigate the influence of gender and type of Diabetes on plasma lipoproteins and post-heparin plasma lipoprotein lipase and hepatic lipase activities. DESIGN AND PATIENTS: Cross sectional study of 22 lean Type 2 diabetic subjects (11 men, 11 women) individually matched for gender, BMI and HbA1 with 22 Type 1 (C-peptide negative) diabetic subjects. MEASUREMENTS: Samples were taken for fasting lipids and post heparin samples were obtained for estimation of post heparin lipolytic activity. RESULTS: In men, HDL-Cholesterol was higher in Type 1 diabetes [1.56 (range 0.97-2.27) vs 1.07 (0.54-1.78) mmol/l, p = 0.009] and this was reflected in both HDL2-cholesterol [0.42 (0.02-1.36) vs 0.22 (0.01-0.90) mmol/l, p = 0.05] and HDL3-cholesterol [1.00 (0.75-1.51) vs 0.72 (0.53-0.87) mmol/l, p = 0.02] subfractions while serum triglyceride concentrations were similar. Lipoprotein lipase activity was higher in men with Type 1 diabetes [16.2 (6.2-42.4) vs 9.77 (5.6-22.6) mmol/h/l, p = 0.02] while hepatic lipase activities were similar [15.7 (9.3-23.0) vs 14.0 (6.8-24.0) mmol/h/l, NS). In women, there were no significant differences between Type 1 and Type 2 diabetes in triglycerides, HDL-C, HDL2 or HDL3. Lipoprotein lipase activity was higher in Type 1 women [19.3 (14.1-35.7) vs 11.0 (7.2-15.2) mmol/h-1 1-1, p = 0.0006] but lipatic lipase activity was also higher [12.1 (4.8-20.5) vs 7.3 (2.3-21.4) mmol/h-1 1-1, p = 0.023]. CONCLUSION: In non-obese diabetic subjects, men with Type 1 diabetes have higher HDL-cholesterol than those with Type 2 diabetes, possibly due to the action of peripheral insulin on lipoprotein lipase activity, while in women, HDL-cholesterol concentrations were similar in Type 1 and Type 2 subjects possibly because of lowered lipatic lipase activity in Type 2 women which offsets the increased lipoprotein lipase activity of the Type 1 women.

Vestibulocochlear dysfunction in a patient with rheumatoid disease and vasculitis.

The case is described of a patient with rheumatoid disease and evidence of vasculitis who developed acute vestibuloauditory dysfunction resulting in total deafness, which was assumed to be secondary to a vasculitic process affecting the vestibulocochlear nerve. Treatment of the underlying vasculitic process, despite effecting a general improvement of the patient's rheumatoid disease, did not significantly improve the auditory dysfunction.