Study of alpha defensin in coronary artery disease and type 2 diabetes mellitus on the background of metabolic syndrome

Abstract

Background. The prevalence of metabolic syndrome (MS), a cluster of risk factors for type 2 diabetes mellitus (DM) and coronary artery disease (CAD), is increasing annually. MS is associated with an almost 2-fold increase in the risk of cardiovascular complications and 1.5-fold increase in all-cause mortality. Systemic inflammation is considered to be one of the pathogenetic links in the development of MS. The study of alpha defensins as inducers of inflammation with antimicrobial properties in patients with MS is increasing. However, changes in the serum level of alpha defensin in MS, with or without type 2 DM and CAD, remain insufficiently studied that determines the feasibility of conducting this study. The objective: to evaluate serum levels of alpha defensin in individuals with metabolic syndrome, type 2 diabetes mellitus and coronary artery disease. Materials and methods. Fifty-four patients (27 women, 27 men) with MS, type 2 DM and CAD were examined. The research was carried out at the Lviv Regional State Clinical Medical and Diagnostic Endocrinology Center and Lviv Territorial Medical Association “Clini­cal Hospital of Planned Treatment, Rehabilitation and Palliative Care”, Lviv City Clinical Hospital 5. Patients with MS were divided into 3 subgroups, depending on the presence of type 2 DM and CAD. The first subgroup included 18 individuals with MS without type 2 DM and CAD, the second — 18 people with MS and type 2 DM, the third — 18 patients with MS, type 2 DM and CAD. The control group consisted of 16 healthy people (8 men, 8 women), the employees of the Lviv Territorial Medical Association “Clinical Hospital of Planned Treatment, Rehabilitation and Palliative Care”, Lviv City Clinical Hospital 5. In patients, the level of alpha defensin was determined, as well as blood lipids (high-density lipoproteins (HDL), very low-density lipoproteins (VLDL)), and the correlations between the above values were investigated. Results. The level of alpha defensin and blood lipids were examined in patients with MS, type 2 DM and CAD. The content of alpha defensin in all participants with MS, both with and without type 2 DM and CAD (18.40 ± 0.89, 24.4 ± 1.2, and 29.1 ± 1.1 ng/ml), was significantly increased and exceeded the control indicators (3.72 ± 0.36 ng/ml) by 4.95, 6.56, 7.82 times (p < 0.05). The highest parameters of alpha defensin were detec­ted in MS combined with type 2 DM and CAD — 29.1 ± 1.1 ng/ml that significantly exceeded the parameters in patients with MS and type 2 DM (24.4 ± 1.2 ng/ml) and group of MS without type 2 DM and CAD (18.40 ± 0.89 ng/ml; p < 0.05). Values of HDL cholesterol in patients with MS (1.12 ± 0.08 ng/ml), MS and type 2 DM (1.01 ± 0.07 ng/ml), MS, type 2 DM and CAD (0.95 ± 0.05 ng/ml) significantly reduced compared to those in the group of healthy individuals (1.40 ± 0.14 ng/ml; р < 0.05), but no significant difference was found between individual subgroups (p > 0.5). The parameters of VLDL cholesterol were hig­hest in patients with combination of MS, type 2 DM and CAD (1.32 ± 0.05 ng/ml), and significantly exceeded those in patients both with MS and type 2 DM (0.87 ± 0.10 ng/ml), and with MS (0.73 ± 0.06 ng/ml; p > 0.05). Comparative analysis was carried out for alpha defensin and blood lipids. A direct strong correlation (r = 0.72; р < 0.5) was found between alpha defensin and VLDL cholesterol in MS patients. In people with MS, type 2 DM and CAD, a direct strong correlation was also found between alpha defensin and VLDL cholesterol (r = 0.65; р < 0.5). In the group of MS and type 2 DM, a weak correlation was revealed (r = 0.1; р < 0.5). Only weak correlations were found between the levels of alpha defensin and HDL cholesterol (r = –0.15, r = –0.11, r = –0.16; р < 0.5). Conclusions. A significant increase in the le­vel of alpha defensin was detected in patients with metabolic syndrome, type 2 diabetes mellitus and coronary artery disease. HDL cholesterol values are significantly reduced in all patients with metabolic syndrome, regardless of the presence or absence of type 2 diabetes mellitus and coronary artery disease. VLDL cholesterol parameters, depending on combined pathology, were highest in patients with metabolic syndrome, type 2 diabetes mellitus, and coronary artery disease, and significantly exceeded the levels of VLDL cholesterol in patients with both MS and type 2 diabetes mellitus, and with metabolic syndrome. Correlations were found between alpha defensin indicators and VLDL cholesterol, they were especially expressed in the presence of coronary artery di­sease and metabolic syndrome.