Cardiovascular risk factors and LDL subfraction profile in Type 2 diabetes mellitus subjects with good glycaemic control

Abstract

Objectives: To compare cardiovascular risk factors and LDL particle size in well-controlled Type 2 diabetes mellitus and normal subjects. Methods: Ninety-three Type 2 diabetic males and 186 age-matched, male controls were studied. Glycaemic control was stable for at least 3 months prior to recruitment. None were on insulin or lipid lowering therapy. Anthropometric indices, blood pressure, lipids, glucose, insulin, apolipoprotein A1 and B, LDL subfraction by density ultracentrifugation were obtained after an overnight fast of 10 h. Results: Diabetic subjects (mean HbA 1c 6.6%±0.10) did not differ from controls in total cholesterol levels (5.04±0.08 vs. 5.16±0.05 mmol/l, respectively) but had lower serum HDL cholesterol (0.98±0.03 vs. 1.12±0.02 mmol/l, P<0.001), higher serum triglyceride (2.38±0.16 vs. 1.80±0.08 mmol/l, P<0.001), lower LDL 1 and LDL 2 and higher LDL 3 concentration. An LDL 3 concentration exceeding 100 mg/dl was found in 59.1% of diabetics and 39.1% of non-diabetics ( P<0.001). Diabetic subjects also had higher body mass index, waist to hip ratio and insulin resistance (HOMA). Difference in LDL subfraction between groups disappeared after adjustments were made for either triglyceride or HDL cholesterol. Conclusion: Well controlled Type 2 diabetes mellitus subjects exhibit an increased cardiovascular burden through low HDL cholesterol and predominance of small, dense LDL particles.