P 17: Analysis of the relationship between parameters of total and abdominal obesity, levels of lipoproteins and occurrence of coronary heart disease in type 2 diabetes

Abstract

Atherosclerosis is the commonest and the most important cause of coronary heart disease (CHD). Among the risk factors for its occurrence the key ones are diabetes mellitus, obesity and dyslipidemia. Therefore, the aim of this study was to determine the connection between the parameters of total and abdominal obesity, level of lipoproteins and the occurrence of CHD in type 2 diabetes (T2D). The research was conducted on 85 patients, 39 diabetics and 46 nondiabetics divided into the following groups: 18 patients with T2D and previously diagnosed CHD (group 1), 21 patients with T2D but without CHD (group 2), 24 nondiabetics with previously diagnosed CHD (group 3) and 22 nondiabetics without CHD (group 4). As an indicator of total obesity we calculated the body mass index (BMI). As parameters of abdominal obesity waist circumference (WC) and waist to hip ratio (WHR) were used. Total cholesterol (ch), HDL-ch, LDL-ch and Triglycerides (Tg) levels were determined by chromatography. We used also Tg/ HDL-ch ratio as an indicator of structural changes in subfractions of cholesterol particles and an independent risk factor for CHD. We found there is no difference in BMI in group 1 vs group 2 (28.09+/−0.82 vs 28.07+/−0.92 kg/m 2 , p=NS) neither in group 3 vs group 4 (27.58+/−0.97 vs 27.16+/−0.71 kg/m 2 , p=NS). WC and WHR values were significantly higher in group 1 vs group 2 (103.06+/−1.88 vs 97.60+/−1.99 cm, 0.98+/−0.01 vs 0.91+/−0.01; p<0.05 respectively) and in group 3 vs group 4 (95.15+/−2.42 vs 90.10+/−2.55 cm, 0.89+/−0.01 vs 0.83+/−0.01, p<0.05 respectively). Comparing the diabetics and nondiabetics, we have found that WC and WHR were significantly higher in diabetics (100.25+/−1.89 vs 92.50+/−2.53; 0.95+/−0.01 vs 0.86+/−0.01; p<0.05 respectively). There was no difference in levels of total ch between groups 1 and 2 (6.59+/−0.33 vs 6.32+/−0.37 mmol/L; p=NS), but total ch levels were significantly higher in group 3 compared to group 4 (6.27+/−0.20 vs 5.70+/−0.16 mmol/L, p<0.05). LDL-ch levels and Tg levels were significantly higher in group 1 vs group 2 (LDL-ch: 4.39+/−0.32 vs 3.61+/−0.24 mmol/L, p<0.05, Tg: 3.68+/−0.59 vs 3.08+/−0.60 mmol/L, p<0.05) and in group 3 vs group 4 (LDL-ch: 4.05+/−0.2 vs 3.59+/−0.17 mmol/L, p<0.05, Tg: 2.55+/−0.35 vs 1.58+/−0.16 mmol/L, p<0.05). There were no difference in HDL-ch levels between these groups (1: 1.04+/−0.06; 2: 1.14+/−0.08; 3: 1.25+/−0.08; 4: 1.25+/−0.07; 1 vs 2 and 3 vs 4 p=NS). However, Tg/HDL ratio was significantly higher in group 1 vs group 2 (4.11+/−0.88 vs 2.87+/−0.67, p<0.01) and in group 3 vs group 4 (2.18+/−0.34 vs 1.40+/−0.19, p<0.05). Also, by method of correlation, we found that in patients with CHD BMI significantly correlate with Tg and Tg/HDL ratio (r=0.338, p<0.05; r=0.388, p<0.05 respectively), while WC and WHR significantly correlate with Tg (r=0.387, p<0.05; r=0.410, p<0.01 respectively), Tg/HDL ratio (r=0.505, p<0.01; r=0.497, p<o.01 respectively) and HDL-ch (r=-0.450, p<0.01; r=-0.494, p<0.01 respectively). Our results have demonstrated that abdominal obesity disrupts cholesterol reverse path, leading to changes in the structure and composition of the HDL subfraction of cholesterol, which is one of the possible pathogenetic mechanisms of atherogenic effects of abdominal obesity. Also, this suggest that parameters of abdominal obesity could be an useful screening test for detecting people with dyslipidemia and high risk of developing CHD, especially diabetics.