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Background: Incidence of cardiovascular events is increased to two to four times among diabetic patients when compared with non-diabetic. Dyslipidaemia in diabetes is major risk factor for cardiovascular events. Atherogenic indices have been used as major laboratory measures in clinical practice to assess cardiovascular risk. Recent studies, have shown that non-high-density lipoprotein cholesterol and other atherogenic indices is like or better than LDL-C alone in the prediction of CVD incidence and mortality. Aim and Objectives: The aim of this study is to assess the lipid abnormalities with cardiovascular risk using atherogenic coefficient (Ac), Cardiac Risk Ratio (TC/HDLc and LDLc/HDLc), TG/HDLc and Non- HDL in diabetes patients. Materials and Methods: A cross-sectional descriptive study conducted at Bir hospital (tertiary care center) Nepal. Patients diagnosed as diabetes with age 30 years or above were selected in this study during a period of 1 yr. Results: The mean age of the patients enrolled was 55.08±1.11 (34-81) year with male (52 %) to female (48%) ratio is 1.08:1. In this study the mean Non HDLc was 165.24±43.40 mg/dl (65-323) and AC was 4.0±1.09. The finding of AC was slightly higher in female compare to male i.e mean ±S.D 4.07±1.31 and 3.94±1.15. This study show the strong correlation of Non HDLc with total cholesterol (r=.990, p=0.000), LDLc(r=.602,p=0.000),TG (r=.411,p=0.000), LDLc/HDLc (r=.580,p=0.000),TC/HDLc ((r=.866,p=0.000), TG/HDLc (r=.390,p=0.000) and AC (p=0.866). Conclusion: The association between abnormal lipid levels and cardiovascular risk is evident among patients with diabetes mellitus. In this study there is the correlation with FBS, Non HDL-c cholesterol, Cardio risk ratio, TG/HDLc, Atherogenic coefficient. Hence Non-HDL cholesterol and Atherogenic indices proves to be more sensitive and a better predictor of cardiovascular events in diabetes patients.

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Addison’s disease or primary adrenal insufficiency is a condition where there is decreased production of glucocorticoid and mineralocorticoid from adrenal cortex and it’s prevalance is around 100- 140 cases per millions in western societies. It has wide range of clinical features and is a serious condition. If diagnosed and treated in time, patient’s condition can improve significantly. Here we present 37 years old female who presented with wide range of vague clinical features and was in shock and on investigation, her serum sodium was low and potassium level was high. With usual treatment of shock, patient condition didn’t improve. So, echocardiography was done which showed global Left Ventricular wall hypokinesia with left ventrical ejection fraction of 25- 30%. She was also taking treatment for hypothyroidism. Endocrinology consultation was done for her hypothyroidism, hyponatremia and possible adrenal crisis. Serum Cortisol was sent which was found low. With treatment with glucocorticoids and mineralcorticoids, patient improved significantly. She recovered from shock, her serum sodium and potassium became normal and after one month, left ventricular ejection fraction improved to 50%. So, with timely diagnosis and proper treatment, Addison’s disease can be treated easily.