OBJECTIVE -To evaluate the atherogenicity of lipids in coronary patients with normal fasting glucose (NFG), impaired fasting glucose (IFG), and type 2 diabetes.
RESEARCH DESIGN AND METHODS -Serum lipid values, the presence of angiographic coronary artery disease (CAD) at baseline, and the incidence of vascular events over 2.3 years were recorded in 750 consecutive patients undergoing coronary angiography.RESULTS -Triglycerides significantly (P Ͻ 0.001) increased and HDL cholesterol (P Ͻ 0.001) as well as LDL particle diameter (P Ͻ 0.001) significantly decreased from subjects with NFG Ͻ5.6 mmol/l (n ϭ 272) over patients with IFG Ն5.6 mmol/l (n ϭ 314) to patients with type 2 diabetes (n ϭ 164). Factor analysis revealed two factors in the lipid profiles of our patients: triglycerides, HDL cholesterol, apolipoprotein A1, and LDL particle diameter loaded high on an HDL-related factor, and total cholesterol, LDL cholesterol, and apolipoprotein B loaded high on an LDL-related factor. In patients with type 2 diabetes, the HDL-related factor (odds ratio 0.648 [95% CI 0.464 -0.904]; P ϭ 0.011), but not the LDL-related factor (0.921 [0.677-1.251]; P ϭ 0.597), was associated with significant coronary stenoses Ն50%. Consistently, in the prospective study, the HDL-related factor (0.708 [0.506 -0.990]; P ϭ 0.044), but not the LDL-related factor (1.362 [0.985-1.883]; P ϭ 0.061), proved significantly predictive for vascular events in patients with type 2 diabetes. CONCLUSIONS -The low HDL cholesterol/high triglyceride pattern is associated with the degree of hyperglycemia. In coronary patients with type 2 diabetes, this pattern correlates with the prevalence of CAD and significantly predicts the incidence of vascular events.
Diabetes Care 28:108 -114, 2005E pidemiologic data from the Framingham Study (1) and the Multiple Risk Factor Intervention Trial (2) indicate that the risk for cardiovascular death is increased two-to threefold in type 2 diabetic individuals. Moreover, after a first myocardial infarction, cardiovascular morbidity and mortality are increased in patients with diabetes compared with nondiabetic patients (3). In the U.K. Prospective Diabetes Study, protocols targeted to optimize glycemic (4) or blood pressure control (5) failed to significantly reduce the incidence of myocardial infarction. Therefore, and because in the U.K. Prospective Diabetes Study plasma levels of LDL cholesterol and low levels of HDL cholesterol were strong predictors of myocardial infarction (6), the main interest for risk intervention now focuses on lipids. However, it is still not clear which lipoprotein abnormality predominantly endangers diabetic patients.Typically, patients with type 2 diabetes are characterized by hypertriglyceridemia and low HDL cholesterol levels (7), whereas levels of LDL cholesterol have been reported to be normal (7), higher (8) or lower (9) than those in nondiabetic control subjects. Moreover, compositional changes of lipoproteins have been demonstrated: both LDL and HDL are smaller and denser than average (10)...
