Gender characteristics of lipid metabolism in patients with coronary heart disease and type 2 diabetes mellitus

Abstract

Heart and metabolic diseases are very common in society today. There are many special features in their manifestation that have influence on prognosis and therapy approaches. Among them are gender characteristics. The aim of the research was to determine the gender peculiarities of disorders of lipid metabolism in patients with coronary heart disease and type 2 diabetes mellitus (T2DM). The study of the blood lipid spectrum in patients with coronary heart disease and T2DM was conducted in 72 patients aged 37 to 85 years old. The patients with coronary heart disease were divided into 2 groups depending on the presence or absence of T2DM: 1 group (n = 40) – patients with coronary heart disease only (Stable Angina Pectoris); group 2 (n = 32) – patients with coronary heart disease and T2DM. Each group was divided into subgroups depending on the gender of the patients: 1A and 2A – males, 1B and 2B – females. Despite the presence of T2DM, a majority of patients with coronary heart disease were overweight and obese. At the same time, obesity was more common in the female subgroups (1B – 45.0%, 2B – 64.7%) than in the male subgroups (1A – 35.0% and 2A – 33.3% respectively). There was an increase in the levels of total cholesterol, triglycerides and low-density lipoproteins for impaired lipid metabolism in patients with coronary heart disease. There was a slightly higher level of total cholesterol (6.12 ± 2.06 mmol/L) and low-density lipoproteins (4.24 ± 1.79 mmol/L) and a lower level of triglycerides (1.63 ± 0.65 mmol/L) in females than in males (5.15 ± 1.29, 3.71 ± 1.14 and 2.40 ± 1.06 mmol/l, respectively). Disruption of lipid metabolism was characterized predominantly by an increase in levels of triglycerides and low-density lipoproteins in blood in patients with coronary heart disease and T2DM regardless of gender. About a quarter of males (25.0% with coronary heart disease and 26.7% with coronary heart disease with T2DM) and females with T2DM (23.5%) reached the target total cholesterol level (<4.0 mmol/L), less frequently females with coronary heart disease (15.0%). The incidence of low-density lipoproteins target (<1.8 mmol/L) was significantly lower than total cholesterol: about 5.0% in males (regardless of the presence of T2DM) and 10.0% in females with coronary heart disease. Women with coronary heart disease and T2DM did not reach the target low-density lipoproteins level (<1.8 mmol/L). In most patients with coronary heart disease dyslipidemia grade II by Fredrickson was observed regardless of the presence of T2DM: in 100% of patients with coronary heart disease and 81.1% of patients with coronary heart disease and T2DM. A distinctive feature of impaired lipid metabolism in patients with coronary heart disease and T2DM is the presence in some of patients of Dyslipidemia grade IV by Fredrickson (6.7% of males and 5.9% of females) and the absence of Dyslipidemia class IIa in males in this group. Analysis of the achievement of the target levels of total cholesterol and low-density lipoproteins indicates insufficient prescribing of adequate hypolipidemic therapy for patients with coronary heart disease and T2DM.