Lipid Profile in Indian Patients With Type 2 Diabetes: The Scope for Atherosclerotic Cardiovascular Disease Risk Reduction

Abstract

OBJECTIVE | Reduction of atherosclerotic cardiovascular disease (ASCVD) risk in patients with diabetes requires proper management of lipid parameters. This study aimed to find the pattern of dyslipidemia and scope of ASCVD risk reduction in patients with diabetes by lipid management.METHODS | Clinical, biochemical, and medication profiles of all patients with diabetes attending a tertiary diabetes care hospital over a 2-year period were collected. The prevalence of various lipid abnormalities was determined after excluding patients with thyroid dysfunction and those on lipid-lowering medications. Patients were stratified according to LDL cholesterol, HDL cholesterol, and triglyceride levels, and other clinical parameters were compared among the groups. The adequacy of statin treatment was assessed based on American Diabetes Association guidelines.RESULTS | Nine hundred and seventy-one patients were included. The prevalence of hyperlipidemia was 40.0%, of whom 14.6% were newly diagnosed. The most common lipid abnormality was elevated LDL cholesterol. Higher A1C and fasting blood glucose values were found to be associated with higher LDL cholesterol levels. Twenty-seven percent of patients with indications for treatment with statins were receiving them. Of those being treated with statins, 42.6% had an LDL cholesterol level $100 mg/dL. CONCLUSION | In South Indian patients with type 2 diabetes and fair glycemic control, high LDL cholesterol is the predominant lipid abnormality. There remains a huge potential for ASCVD risk reduction in this population if the knowledge practice gap is addressed.Type 2 diabetes requires proper management of lipid parameters and hypertension in addition to glycemic control to ensure prevention of chronic complications, especially negative macrovascular outcomes. The prevalence of macrovascular complications of diabetes is much higher in Indians than in Caucasians, even though the prevalence of microvascular complications is comparable in these populations (1,2).Only a few studies of lipid parameters in Indian patients with diabetes have been conducted. This knowledge deficit is particularly worrisome with regard to the population of South India, and especially in the state of Kerala, where the predicted risk of atherosclerotic cardiovascular disease (ASCVD) is the highest among the Indian states, with an age-standardized state-level mean 10-year ASCVD risk of 30.4% among males (3). The prevalence of dyslipidemia among people $30 years of age in South India is 74.8% in urban populations (4).International guidelines on the treatment of dyslipidemia in patients with type 2 diabetes advocate aggressive lowering of LDL cholesterol in patients with diabetes based on strong evidence from clinical trials. Therapeutic inertia with regard to glucose, blood pressure, and lipid management in patients with diabetes has been demonstrated in multiple studies around the world (5,6). This study assesses the prevalence and pattern of dyslipidemia, as well as the

Diabetic Uterine Environment Leads to Disorders in Metabolism of Offspring

“…Maternal diabetes is a pathologic state that increases the incidence of complications in both the mother and the fetus ( Vrachnis et al, 2012 ), for example, low quality oocytes ( Zhang et al, 2013 ), increased chances of miscarriage ( Mills et al, 1988 ) and congenital malformations of offspring ( Vitoratos et al, 2010 ). Moreover, diabetic persons are considered to have significant positive relation for formation of hypercholesterolemia ( Chowdhury and Nessa, 2019 ) and high LDL cholesterol ( Jayakumari et al, 2020 ). Previous study has demonstrated that epigenetic inheritance via gametes by itself could increase an offspring’s susceptibility to develop to obesity and type 2 diabetes ( Huypens et al, 2016 ).…”

Correlation of lipid profile in diabetes patients

“…Another study supported these findings that showed a significant correlation between lipid profile and HbA1c in diabetic patients associated with CVD. (17) This finding suggests that improved glycemic control, as shown by lower levels of FPG and HbA1C, would probably result in TG levels and lower LDL cholesterol in diabetic patients. As a result, medications for lowering lipid may be postponed till glycemic control is reached and a clearer representation of lipid pattern for patient is developed.…”

Small Dense Low-Density Lipoprotein Level in Newly Diagnosed Type 2 Diabetes Mellitus Patients With Normal Low-Density Lipoprotein

“…Newly diagnosed T2DM patients are commonly screened for the lipid profile and antilipidemic drugs are suggested if the levels are high for the individual [6]. Those who have their LDL cholesterol (LDL-C) in the normal range may have underlying risks of cardiovascular diseases associated with a higher percentage of sdLDL cholesterol (sdLDL-C) level.…”