Dr. Arul Senghor et al.

, IJSID, 2012, 3 (1), 51-55

ISSN:2249-5347

IJSID

International Journal of Science Innovations and Discoveries

Research Article

An International peer Review Journal for Science

Available online through www.ijsidonline.info

*Associate Professor, **Professor & Head, ***M. Sc Post Graduate *Dr. Arul Senghor, Dr. Ebenezer William**, Jeevanathan***

NON-HDLc COMPARED TO DIRECT LDLc IN DIABETIC PATIENTS WITH HYPERTRIGLYCERIDEMIA Department of Biochemistry, SRM Medical College Hospital & RC, Kattankulathur.

Received: 10-01-2013 Accepted: 05-02-2013

*Corresponding Author

ABSTRACT Background: Diabetic dyslipidemia is characterized by elevated triglycerides, LDLc and decreased levels of HDLc. Non-HDLc is considered to be a measure of apo B containing atherogenic lipoproteins and a better predictor of CVD in type 2 DM. The aim of this study recruited and divided into group A ( triglycerides < 150 mg/dL) and group B (triglycerides is to evaluate non-HDLc and LDLc in diabetic patients with hypertriglyceridemia. Materials & Methods: Among 320 patients, 120 patients aged 25 to 75 years were > 150 mg/dL). Fasting blood samples were analyzed for FBG, Total cholesterol, calculated. Results: Hypertriglyceridemic type 2 Diabetic patients had increased HbA1c

Address: Name: Dr. K. A. Arul Senghor Place: Kattankulathur E-mail: arul_senghor@yahoo.co.uk

triglycerides, HDLc and HbA1c. LDLc was estimated by direct method and non-HDLc was with elevated FBG levels and showed significantly increased non-HDLc (p< 0.001) and LDLc (p< 0.008) than diabetes with normotriglyceridemia. Non-HDLc showed a significant HDLc is considered to be a better representative of triglyceride rich lipoprotein than LDLc which can assess the unrecognized high risk lipid profile in type 2 Diabetes mellitus. Keywords: Non-HDLc, LDLc, hypertriglyceridemia. correlation with INTRODUCTION FBG(r=0.9), triglycerides(r=0.89) and LDLc(r=0.66). Conclusion: Non-

INTRODUCTION

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Dr. Arul Senghor et al., IJSID, 2012, 3 (1), 51-55 Federation, the number of diabetic patients in India is expected to increase to 69.9 million in 2025. Cardiovascular disease (CVD) is currently the prime cause of morbidity and mortality in type 2 DM (1). The elevated CVD risk in diabetic patient is lipoprotein, apo B, LDLc particles of altered composition and low HDLc (2, 3). LDLc, one of the parameter of lipid profile is routinely used by the General practitioners in atherosclerosis risk Diabetes mellitus is one of the most serious public health problems in India. According to International Diabetes INTRODUCTION

attributed by a combined unnoticed dyslipidemia characterized by elevated triglycerides, triglyceride rich remnant assessment. But LDLc reflects only the amount of cholesterol contained in LDL particle and not the other lipoprotein fractions that are essential in the development of atherosclerosis. LDLc is usually calculated by Friedwald formula but has its limitations when triglyceride concentration is elevated. It was shown that LDLc is estimated with approximately 17% and 25% error at on detection, evaluation and treatment of high cholesterol (ATP III) continued to recognize LDLc as the primary target for cholesterol lowering therapy (5). But the target of lowering LDLc results only 25% to 35% risk reduction of CVD. serum triglyceride concentration from 151 200 mg/dL and 201 300 mg/dL respectively (4). The expert panel from NCEP

cholesterol fraction is simply defined as the difference between total cholesterol and HDLc. The measurement of non-HDLc is simple, more practical, reliable and inexpensive. It is considered as a surrogate marker of apolipoprotein B, since it represents diabetes (2). Hence, this study primarily aims to determine and compare non-HDLc with LDLc in type 2 Diabetic patients with hypertriglyceridemia to identify the high risk lipid profile leading to CVD. the study. The institutional Ethical Committee approved the study and informed consent was obtained from the patients. Inclusion criteria with triglycerides > 150 mg/dL. The triglyceride level was defined as per NCEP ATP III. Exclusion criteria obstructive liver disease were also excluded. Among 320 diabetic patients who visited the Diabetic outpatient clinic of our hospital, 120 patients were included in MATERIALS AND METHODS is a strong predictor of CVD risk in a variety of population, individuals of all ages, males, females and patients with and without

the pro atherogenic apo B containing particles like VLDL, LDL, IDL and lipoprotein (a) (6). Recent data suggest that non-HDLc

Recently NCEP has recognized non-HDLc as one of the emerging novel risk factor. Non-HDLc, a beta lipoprotein

than 5 years were recruited for this study. Divided into group A (n= 46) with triglycerides < 150 mg/dL and group B (n=74) Diabetic patients on hypolipidemic drugs were excluded from the study. Patients with thyroid disorders and

Type 2 Diabetic patients aged 25 to 75 years of either sex and duration of history of DM more than 1 year and less

(FBG), Total cholesterol (TC), Triglycerides, HDLc by enzymatic method; LDLc by direct assay. HbA1c was analyzed in whole Value of HbA1c was given as % of total Hb.

blood sample by turbidimetric method. Non-HDLc was calculated. For serum lipid reference level, National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) guideline was referred. Dyslipidemia was defined by presence of one or more abnormal serum lipid concentration. Diabetes was defined as per American Diabetes Association (ADA) criteria.

Fasting venous blood samples were collected and analyzed in Olympus AU 400 auto analyzer for fasting blood glucose

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Dr. Arul Senghor et al., IJSID, 2012, 3 (1), 51-55 Statistical analysis (S.D.). P < 0.05 was considered statistically significant. Pearsons correlation co-efficient was performed to examine correlation between various parameters. normotriglyceridemic and hypertriglyceridemic groups. Prevalence of hypertriglyceridemia in type 2 DM was 62%. The lipid triglycerides and LDLc. Parameters Total cholesterol mg/dL Triglycerides mg/dL Non-HDLc mg/dL HDLc mg/dL LDLc (Direct) mg/dL The biochemical lipid profile data of the diabetic patients are shown on table (1). 120 type 2 DM were divided into RESULTS Statistical analysis was performed with students test and the results are expressed as mean standard deviation

profile parameters were studied between the groups and on comparison table (2) the results of non-HDLc and LDLc were Table 1: Biochemistry lipid profile parameters characterized by DM patients triglyceridemic status. Normal triglycerides < 150 mg/dL (n= 46) 169.5 23.32 132.0 16.01 45.0 5.6 85.72 16.07 Borderline high triglycerides: 150 199 mg/dL (n= 57) 227.3 37.76 172.01 14.28 34.28 4.8 147.21 14.67 High triglycerides: 200 499 mg/dL (n= 16) 259.65 13.6 286.21 33.5 Very high triglycerides: 500 mg/dL (n= 1) 301.5 627.3 22.48 237.09 279.02

significantly increased with the severity of hypertriglyceridemia. As per table (3), non-HDLc was correlated with FBG,

Table 2: Comparison of Non-HDLc and LDLc in Normo and Hypertriglyceridemic type 2 DM Group A Type 2 DM (n= 46) Triglyceride < 150 mg/dL 124.5 17.72 85.12 16.07 37.23 4.9 102.20 9.17 6.01 3.9 Group B Type 2 DM (n=74) Triglyceride > 150 mg/dL 233.8 24.37 182.96 15.49 31.70 6.0 138.20 28.17 8.8 1.29 P value 0.001 0.008 0.012 0.017 0.024

124.5 17.72 193.02 32.78 229.48 17.8 Values are expressed in Mean Standard Deviation

30.17 2.98 164.67 17.05

Parameters Non-HDLc mg/dL LDLc mg/dL HDLc mg/dL FBG mg/dL HbA1c %

Values are expressed in Mean Standard Deviation; P value < 0.05 is considered significant. Table 3: Correlation between Non-HDLc with FBG, triglycerides and LDLc Parameters Fasting blood glucose mg/dL Triglycerides mg/dL LDLc mg/dL r - value 0.9 0.89 0.66 Correlation + + +

the plasma lipid components involved in atherogenesis. Non-HDLc is considered to be a better predictor of risk assessment of does not reflect the true level of cardiovascular risk. NCEP has recognized non-HDLc as the emerging marker of atherogenicity International Journal of Science Innovations and Discoveries, Volume 3, Issue 1, January-February 2013

CVD than the simple measure of LDLc. Since the amount of LDLc inside the lipoprotein particle varies in each individuals and

Modern laboratory diagnosis of dyslipidemia and cardiovascular risk is based on the use of indicators that highlights DISCUSSION

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and can be used as secondary target of therapy in DM patients with triglycerides > 200 mg/dL (5). Non-HDLc includes the assessment of all the atherogenic apo B containing lipoprotein ie. VLDL, IDL, LDL and lipoprotein (a). Apart from LDLc, which is the major determinant of atherosclerosis, triglyceride rich lipoprotein, VLDL remnants and IDL accumulates that are triglyceride levels (8). Even increased VLDL is associated with increases in prothrombotic and procoagulant factors. Since diabetes is associated with many lipoprotein abnormalities, an easily measured indicator like non-HDLc is useful to clinicians. taken up by macrophages leading to foam cell formation and thereby accelerates atherosclerosis in patients with elevated

Dr. Arul Senghor et al., IJSID, 2012, 3 (1), 51-55

Furthermore, a significant increase of non-HDLc on comparison with LDLc was observed in hypertriglyceridemic diabetic patients. In Strong Heart Study, the results indicated that non-HDLc is a strong predictor of CVD in men and women with diabetes and is also indicative of coronary events (9). The impact of elevated triglyceride levels in calculation of LDLc with Friedwald formula suggests that non-HDLc is in fact more beneficial to determine the risk of atherosclerosis and CVD in non-HDLc and LDLc in patients with combined Hyperlipidemia (11). A routine calculated LDLc has its limitations and direct LDLc assay is expensive. Furthermore, LDLc fails to be an CONCLUSION patients with hypertriglyceridemia (10). Our study analyzed and found a better correlation of non-HDLc with FBG, LDLc and adequate index of overall atherogenic lipoproteins. Thus non-HDLc represents a readily available, inexpensive and reflects the proatherogenic particles especially in Diabetic patients with hypertriglycerides and can conveniently measure the CVD risk. patients thereby reduces the risk and incidence of CVD. 1. 2. 3. 4. 5. 6. 7. 8.

Our study showed that DM patients with hypertriglycerides had elevated non-HDLc, LDLc and decreased HDLc levels.

triglycerides. These findings are consistent with other studies where the subanalysis of SAFARI Trial studied the correlation of

atherogenic lipoprotein. Appropriate attention is necessary in targeting and lowering Non-HDLc in hypertriglyceridemic DM The authors thank the diabetic subjects under study and Mr. M. Srinivasan for the statistical support. ACKNOWLEDGEMENT REFERENCES

Thus for Diabetic patients with fasting hypertriglyceridemia, Non-HDLc is considered as representative of all

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Liu J, Sempons C, Donahue RP, Dorn J, Trevisan M, Grundy SM. Joint distribution of non-HDLc and LDLc and coronary heart Fukuyama N, Homma K, Wakana N et al. Validation of the Friedwald equation for evaluation of plasma LDL cholesterol. J Executive summary of the Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, Evaluation and Treatment of high blood cholesterol in Adults (Adult Treament Panel III). JAMA. 285, 2001, 2486 2497. Anne L. Peters. Clinical relevance of non-HDL cholesterol in patients with diabetes. Clinical Diabetes. 26(1), 2008 , 3 7. therapy. Circulation. 106, 2002 , 2526 2529. Havel RL, Rapaport E: Management of primary Hyperlipidemia. N Engl J Med 332, 1995, 1491 1498.

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10. Shimano H, Arai H, Harada-Shiba M., et al. Proposed guideline for hypertriglyceridemia in Japan with non-HDLc as the 11. Grundy SM, Vega GL, Tomassini LE et al. correlation of non-high density lipoprotein and low-density lipoprotein cholesterol with apolipoprotein B during simvastatin-fenofibrate therapy in patients with combined Hyperlipidemia (a subanalysis of the SAFARI Trial). Am J Cardiol. 104, 2009 , 548 553,. second target. J Atheroscler Thromb. 15(3), 2008116 121.

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