Abstract
BackgroundThere are inconsistent data about the role of serum phospholipid fatty acid composition in patients with type 2 diabetes (T2DM) and atherosclerotic cardiovascular disease (ASCVD). The aim of the study was to investigate the relationship between serum phospholipid fatty acid composition, systemic low-grade inflammation, and glycemic control in high-risk T2DM patients.MethodsSeventy-four patients (26% women, mean age 65.6 ± 6.8 years) with T2DM (median diabetes duration 10 years) and documented ASCVD (74 with coronary artery disease, 26 with peripheral arterial disease) were enrolled in the study. Baseline HbA1c was estimated using turbidimetric inhibition immunoassay. According to the median value of HbA1c the patients were grouped into those with HbA1c < 7.0% (< 53 mmol/mol) (n = 38) and those with HbA1c ≥ 7.0% (≥ 53 mmol/mol) (n = 36). Serum phospholipid fatty acids were measured with gas chromatography.ResultsPatients with HbA1c ≥ 7.0%, compared with those with HbA1c < 7.0% had similar composition of saturated and monounsaturated fatty acids in serum phospholipids, but had higher concentrations of linoleic acid (LA) and higher n-6/n-3 polyunsaturated fatty acid (PUFA) ratio as well as lower levels of eicosapentaenoic acid (EPA), total n-3 PUFAs, and the EPA/arachidonic acid ratio. We found that LA (r = 0.25; p = 0.03) and n-6/n-3 PUFA ratio (r = 0.28; p = 0.02) were positively correlated with HbA1c. Multivariate logistic regression analysis showed that n-6/n-3 PUFA ratio, hsCRP and T2DM duration were independent predictors of worse glycemic control in patients with T2DM and ASCVD.ConclusionsThis study showed that glycemic control in high-risk T2DM patients with ASCVD was significantly associated with unfavorable serum phospholipid n-6/n-3 PUFA ratio and greater systemic inflammation.
Highlights
There are inconsistent data about the role of serum phospholipid fatty acid composition in patients with type 2 diabetes (T2DM) and atherosclerotic cardiovascular disease (ASCVD)
The predictive model showed good cross-validated calibration and discrimination with Hosmer–Lemeshow χ2 = 10.73, p = 0.21 and AUC = 0.872, respectively. To our knowledge, this is the first study to show that a poor glycemic control (glycated hemoglobin (HbA1c) ≥ 7.0%) in high-risk diabetic subjects with ASCVD is associated with decreased levels of eicosapentaenoic acid (EPA), total n-3 polyunsaturated fatty acids (PUFAs), and lower EPA/arachidonic acid (AA) ratio in the serum phospholipid fraction
We suggested that longer time of administration and/or higher doses of EPA-docosahexaenoic acid (DHA) as well as improvement in oral bioavailability of n-3 PUFAs may ameliorate glycemic control in type 2 diabetes mellitus (T2DM) patients
Summary
There are inconsistent data about the role of serum phospholipid fatty acid composition in patients with type 2 diabetes (T2DM) and atherosclerotic cardiovascular disease (ASCVD). The aim of the study was to inves‐ tigate the relationship between serum phospholipid fatty acid composition, systemic low-grade inflammation, and glycemic control in high-risk T2DM patients. The underlying mechanisms linking T2DM with atherosclerotic cardiovascular disease (ASCVD) remain not fully understood. Numerous experimental and clinical studies have shown the close relationship between dysglycemia and increased risk for ASCVD, with an estimated 11–16% increase in cardiovascular events for every 1% increase in glycated hemoglobin (HbA1c) level [4]. It has been shown that HbA1c levels of ≥ 7.0% (≥ 53 mmol/mol) were associated with unfavorable cardiovascular outcomes in T2DM patients with established atherosclerosis [12]
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