Dyslipidemia In Diabetic Patients Research Articles

Effect of vildagliptin and pravastatin combination on cholesterol efflux in adipocytes.

Many reports suggested that some statins are almost ineffective in reducing triglycerides or enhancing HDL-C plasma levels, although statin treatment was still efficacious in reducing LDL-C. In diabetic dyslipidemic patients, it may therefore be necessary to use a combination therapy with other drugs to achieve either LDL-C- and triglyceride-lowering or HDL-C-enhancing goals. Such ineffectiveness of statins can be attributed to their effect on the liver X receptor (LXR) which regulates the expression of the ATP-binding cassette (ABC) transporters ABCA1 and ABCG1. A decrease in the expression of these transporters eventually leads to decreased cholesterol efflux from peripheral tissues leading to low levels of HDL-C. Although manipulating the LXR pathway may complement the effects of statins, LXR synthetic ligands as T091317 have shown significant hypertriglyceridemic action which limits their use. We recently found that the antidiabetic drug vildagliptin stimulates LXR expression leading to increased ABCB1/ABCG1 expression which improves cholesterol efflux from adipocytes. Therefore, a combination of vildagliptin and statin may provide a solution without the hypertriglyceridemic action observed with LXR agonist. We hypothesize that a combination of vildagliptin and pravastatin will improve cholesterol efflux in adipocytes. Statin-treated 3T3-L1 adipocytes were treated with vildagliptin, and the expression of LXR-ABCA1/ABCG1 cascade and the cholesterol efflux were then determined. Our data indicate that a combination of vildagliptin and pravastatin significantly induces the expression of LXR-ABCA1/ABCG1 cascade and improves cholesterol efflux (P > 0.05) in adipocytes. Our data may explain, at least in part, the improvement in HDL-C levels observed in patients receiving both medications. © 2016 IUBMB Life, 68(7):535-543, 2016.

Clinical benefits of pitavastatin: focus on patients with diabetes or at risk of developing diabetes.

Despite attaining LDL-cholesterol targets, many patients with diabetes remain at risk of developing cardiovascular events. In addition, treatment with statins has been associated with a slight but significant increased risk of development of diabetes, particularly with high-intensity statins. Pitavastatin is a moderate- to high-intensity statin that effectively reduces LDL-cholesterol levels. Pitavastatin provides a sustained increase of HDL-cholesterol levels that may exhibit a neutral or positive effect on glucose metabolism, may not increase the risk of new-onset diabetes, may exhibit positive effects on renal function and urinary albumin excretion and the risk of drug-drug interactions is low. Therefore, it seems that pitavastatin should preferentially be considered in the treatment of dyslipidemia in diabetic patients or at risk of developing diabetes.

Evaluation of Electrolytes Imbalance and Dyslipidemia in Diabetic Patients

Electrolytes and Lipids have always played significant roles, and changes in their concentrations gives good indications of disease progression in a number of non-communicable diseases. Diabetes mellitus is the most common metabolic disorder in the community. Diabetics may suffer from electrolyte disorders due to complications of diabetes mellitus and the medication they receive. Serum glucose, electrolytes (Na+, K+, Cl− and Ca++), and lipid profiles (total cholesterol, triglyceride, and HDL-c) were determined in 100 diabetics and in non-diabetic subjects. All the diabetic patients had a significant (p < 0.001) increase in glucose, total cholesterol, triglyceride, chloride and calcium levels. There was significant (p < 0.001) decrease in the serum levels of Na+ and K+ in all diabetics. It was concluded that differences in lipids and electrolytes found in diabetics may have great potential as a diagnostic tool in clinical practice and have a significant effect upon the risk of contracting many diseases.

The status and progress of relationship between dyslipidemia and diabetic retinopathy

Dyslipidemia plays an important role in the pathogenesis of diabetic retinopathy (DR). A preliminary study found that low-density lipoprotein cholesterol, apolipoprotein (Apo) B and Apo B / Apo A1 ratio were positively correlated with DR, while high-density lipoprotein cholesterol, Apo A1 was negatively correlated with DR and proliferative DR. Reducing the blood fats to be helpful to DR control. However, the mechanism of hyperlipidemia in the pathogenesis of DR, the reason of dyslipidemia in diabetic patients and the interaction between hyperglycemia and hyperlipidemia in DR are not clear yet. Moreover, there is no predictive indicators related to blood lipid for DR. Understanding the relationship between dyslipidemia and DR can provide definite evidence for fat-reducing therapy for DR control. Key words: Diabetic retinopathy/etiology; Dyslipidemias; Review

Effects of Aloe Vera Supplements on Blood Glucose Level and Lipid Profile Markers in Type 2 Diabetic Patients – a Randomized Clinical Trial

One of the most studied methods to adjust the blood glucose level and dyslipidemia in diabetic patients is administrating of herbal supplements. This double blinded randomized clinical trial (RCT) study we are aimed to study the effect of Aloe vera supplements on blood glucose level and lipid profile of diabetes mellitus type 2 patients. Methods: 44 patients (25 male and 19 female) fulfilling inclusion criteria, were divided into two groups of intervention and placebo randomly. The patients in intervention group received 1000 mg of Aloe vera supplements and the patients of placebo group received placebo, daily for two months beside the main treatment for diabetes mellitus. Before and after the intervention blood samples were taken from all the patients; and were measured for blood glucose level and lipid profile. The data were analyzed using independent T-test method. This RCT study was submitted in IRCT center by submitted code of IRCT201307269626N3. Results: The results revealed that the levels of the fasting blood sugar (FBS), HbA1c, Total Cholesterol, Triglyceride, high density lipoprotein (HDL), low density lipoprotein (LDL) were not significantly different between the pre-intervention and post intervention blood samples in both intervention and placebo group. Also there was not any significant difference in blood glucose level and lipid profile comparing intervention and placebo groups. Conclusion: In this study, we can conclude that Aloe vera supplement beside the main treatment for diabetes mellitus has no significant effect in blood glucose level and lipid profile in diabetes mellitus type 2 patients.

English

Diabetes mellitus (DM) is a common endocrine metabolic disorder and a leading cause of death worldwide. Dyslipidemia is a well-recognized manifestation of uncontrolled DM, because insulin has important regulatory effects on lipid metabolism. This study was conducted to determine the frequency and pattern of dyslipidaemia in diabetic patients. Cross-sectional study was conducted on a total of two hundred ninety five diabetic patients attending diabetic follow-up clinic of Hawassa University Referral Hospital from March to November, 2014. For each selected subject, structured questionnaire about socio-demographic characteristics and diabetic related information was filled; overnight fasting blood samples were analyzed for fasting blood sugar (FBS) and lipid profiles, namely, total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL). Dyslipidemia was assessed according to the United State National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III) model guideline. SPSS version 20 was used as tool for data analysis. P-value of <0.05 was used as statistical significance. The mean (± standard deviation, SD) values of TC, TG, HDL, LDL were 186.03 (± 37.40), 194.33 (± 93.38), 49.66 (± 10.34), 119.15 (± 42.33) mg/dl, respectively. Among all of the diabetic patients, 34.9% had high serum LDL, 34.6% had hypercholesterolemia, 29.8% had hypertriglyceridemia and 12.2% had low HDL. Significantly higher mean serum levels of TC (p = 0.002) and LDL (p = 0.008) were noted in type 2 DM than type 1 DM. Females had significantly higher TC and LDL levels than males; whereas males had significantly lower HDL levels as compared to females (48.04 ± 9.13 versus 51.93 ± 11.49 mg/dl; p < 0.001). The mean (± SD) FBS level was 178.18(± 85.39) mg/dl and patients with type 1 DM had significantly higher FBS than those with type 2 DM (p < 0.001). Our study showed the presence of dyslipidaemia in Ethiopians with DM. The most common dyslipidemia in this study was high level of serum LDL followed by hypercholesterolemia and hypertriglyceridemia. The optimal care for diabetic patients should also include routine monitoring of serum lipid profile. Key words: Diabetes, lipid profile, dyslipidemia.

Newer targets and therapies for hypertension and dyslipidemia in diabetic patients

Newer targets and therapies for hypertension and dyslipidemia in diabetic patients

Determinants of Bezafibrate-induced Improvements in LDL Cholesterol in Dyslipidemic Patients with Diabetes.

Our previous "J-BENEFIT (Japan BEzafibrate cliNical EFfectIveness and Tolerability)" study demonstrated that bezafibrate improves blood lipid profiles and glucose control in dyslipidemic patients with diabetes. However, bezafibrate did not significantly improve low-density lipoprotein cholesterol (LDL-C), although some patients showed decreases while others showed increases in the LDL-C levels. Therefore, a subgroup analysis of the J-BENEFIT study was conducted to identify factors influencing the bezafibrate-induced changes in the LDL-C levels. Of the 3,316 patients in the J-BENEFIT study, 2,116 not treated with other lipid-lowering drugs were enrolled in the current study, and the effects of 24-week treatment with bezafibrate on the LDL-C levels were analyzed. A reduction in the LDL-C level of ≥ 25% occurred in 253 patients, and a logistic-regression analysis was used to identify factors associated with this improvement. Among the 2,116 overall patients, bezafibrate treatment significantly increased the LDL-C levels from 123.9±36.7 to 125.7±31.3 mg/dL. The subanalysis showed that the treatment responses varied according to the baseline LDL-C level, with significant decreases in the ≥ 160 and ≥ 140-＜160 mg/dL groups, no significant decrease in the ≥ 120-＜140 mg/dL group and a significant increase in the ＜120 mg/dL group. A multivariate logistic-regression analysis of the data for the patients with an LDL-C of ≥ 25% identified a female sex, the use of anti-hypertensive and hypoglycemic agents and a high baseline LDL-C level to be significant determinants of the LDL-C response to bezafibrate. Our results showed that treatment with bezafibrate improves the LDL-C levels and lipid profiles in dyslipidemic diabetic patients, especially women, subjects co-treated with anti-hypertensive or hypoglycemic agents and those with high baseline LDL-C levels.

Comparison of Cost-Effectiveness, Safety, and Efficacy of Rosuvastatin Versus Atorvastatin, Pravastatin, and Simvastatin in Dyslipidemic Diabetic Patients With or Without Metabolic Syndrome

The aim of the current study was to determine the efficacy of the 4 most commonly prescribed statins (rosuvastatin, atorvastatin, pravastatin, and simvastatin) for managing dyslipidemia among diabetic patients with and without metabolic syndrome (MetS). This was a cohort observational population-based study conducted at Hamad Medical Hospital and Primary Health Care Centre. The participants were 1542 consecutive diabetes patients who were diagnosed with dyslipidemia and were prescribed any of the indicated statins. Sociodemographic and clinical characteristics were taken from medical records, and lipid profile at baseline and 2 years after the initiation of statin therapy were retrieved from electronic medical records database (EMR-viewer). Reduction in different lipid profile after 2 years of therapy was compared among different types of statins between patients with and without MetS. Out of total 1542 subjects, 562(36.4%) were diagnosed with MetS using the criteria of International Diabetes Federation. Among those with MetS, 125 were prescribed with atorvastatin, 162 pravastatin, 177 rosuvastatin, and 98 simvastatin. Among those without MetS, 365 used atorvastatin, 172 pravastatin, 345 rosuvastatin, and 98 simvastatin therapies. Among patients with MetS, rosuvastatin therapy resulted in significantly higher low-density lipoprotein cholesterol and total cholesterol reduction (23%, P = .006; and 20.3%, P = .015, respectively) as compared with other statins. Similarly, significantly higher percentage of patients receiving rosuvastatin therapy were successful in achieving the target of total cholesterol <4 mmol/L and triglycerides <1.7 mmol/L after 2 years (38.4%, P = .012; and 67.2%, P = .010, respectively) as compared with other therapies. In contrast, among patients without MetS, rosuvastatin therapy resulted in highest percentage drop in total cholesterol (20.1%; P = .016) than other statin therapies. The present study confirmed that rosuvastatin therapy in commonly prescribed doses is the most effective statin for low-density lipoprotein cholesterol goal achievement and for improving the lipid profile in hypercholesterolemic diabetic patients with and without MetS.

Comparison of efficacy, safety, and cost-effectiveness of various statins in dyslipidemic diabetic patients

Background and Aim:To determine efficacy safety and the cost effectiveness, of the four most commonly prescribed statins (rosuvastatin, atorvastatin, pravastatin, and simvastatin) in the treatment of dyslipidemia among diabetic patients.Materials and Methods:This is a cohort, observational, population-based study conducted at diabetic clinics of the Hamad Medical Hospital and Primary Health Care Centers (PHCC) over a period from January 2007 to September 2012. The study included 1,542 consecutive diabetes patients above 18 years of age diagnosed with dyslipidemia and prescribed any of the indicated statins. Laboratory investigations were taken from the Electronic Medical Records Database (EMR-viewer). The sociodemographic, height, weight, and physical activities were collected from Patient's Medical Records. Information about statin was extracted from the pharmacy drug database. The effective reductions in total cholesterol using rosuvastatin with atorvastatin, simvastatin, and pravastatin in achieving cholesterol goals and improving plasma lipids in dyslipidemic diabetic patients were measured. Serum lipid levels measured a 1 week before the treatment and at the end 2nd year.Results:Rosuvastatin (10 mg) was the most effective in reducing low-density lipoprotein cholesterol (LDL-C; 28.59%), followed by simvastatin 20 mg (16.7%), atorvastatin 20 mg (15.9%), and pravastatin 20 mg (11.59.3%). All statins were safe with respect to muscular and hepatic functions. Atorvastatin was the safest statin as it resulted in the least number of patients with microalbuminuria (10.92%) as compared to other statins. Treatment with rosuvastatin 10 mg was more effective in allowing patients to reach European and Adult Treatment Plan (ATP) III LDL-C goals as compared to other statins (P < 0.0001) and produced greater reductions in LDL-C, total cholesterol, and non-HDL-C, produced similar or greater reductions in triglycerides (TGs) and increased in HDL-C.Conclusion:Rosuvastatin 10 mg was the most effective statin in reducing serum lipids and total cholesterol in dyslipidemic diabetic patients.

Prevalence and control of cardiovascular risk factors among type 2 diabetes mellitus patients in southern region of Saudi Arabia

Background/AimDyslipidemia is a significant predictor of cardiovascular events and mortality in diabetes patients. The aim of this study is to estimate the prevalence rates, characteristics of dyslipidemia and their control in outpatient population in a Diabetic Centre. MethodsA cross sectional prospective study design was used to collect data from 255 patients which included patient characteristics, past medical history of CVD, medications and parameters related to DM and cardiovascular risk factor control. Blood pressure and laboratory measurements for glycosylated hemoglobin and lipoprotein panel were recorded. ResultsBody mass index (BMI) of the dyslipidemic diabetic patients was significantly higher for females. In terms of age, duration of diabetes, family history, diabetes treatment offered did not differed significantly among genders. Clinical characteristics of HDL values were significantly higher for female in comparison to men (P = 0.02) whereas glycosylated hemoglobin and blood pressure appeared not to differ significantly. Among the three factors studied BMI, duration of diabetes mellitus and drug therapy on lipoprotein levels of diabetes patients, except for the influence of drug therapy which influenced significantly the total cholesterol level (P = 0.02). Number of females with normolipid were more than males (P = 0.009) and number of males with abnormal cholesterol and triglyceride patients were significantly more than females (0.0002). ConclusionDyslipidemia among males were higher than females which could be a significant risk factor for causing low glycemic control culminating in cardiovascular events. Control of hyperglycaemia and other CVD risk factor appears to be suboptimal in Saudi Arabia. Addressing health system components such as providing medical staff training, incentive to health professionals and better patient education may improve quality of DM care.

Pseudodyslipidemia: are we over-treating dyslipidemia in diabetic patients with undiagnosed gastroparesis?

Management of dyslipidemia in diabetic patients poses a major burden on both patients and healthcare providers. Gastroparesis, a condition in which gastric emptying is delayed, is a common condition in diabetes. Given the fact that normal values of plasma lipids are standardized to be measured after several hours of fasting, delayed transit of food and nutrients into the small bowel (as occurs in gastroparesis) may result in an artificial increase in plasma lipids, causing misdiagnosis of dyslipidemia (pseudodyslipidemia), and lead to overtreatment with lipid-lowering agents.

Evaluation of glutathione S-transferase GSTM1 and GSTT1 deletion polymorphisms on type-2 diabetes mellitus risk.

BackgroundDue to the activity of GSTs in the detoxification of oxidative stress products, deletion polymorphisms of GSTM1 and GSTT1 may contribute to susceptibility to T2DM, since B-cells express very low levels of antioxidant enzymes. Recently, some studies have shown an association between GSTM1-null/GSTT1-null genotypes and an increased susceptibility to T2DM. A relationship between these polymorphisms and changes in the clinical parameters of diabetic patients has also been investigated. However, the results diverge considerably among the studies. Thus, this case-control study was designed to contribute to existing knowledge, as there are no studies on this issue performed in the Brazilian population.Methods and FindingsA total of 120 patients and 147 healthy individuals were included in this study. GSTT1 and GSTM1 deletion polymorphisms were genotyped by multiplex SYBR Green Real-Time PCR. The GSTT1-null genotype conferred a 3.2-fold increased risk to T2DM relative to the present genotype. There was no association between GSTM1-null and T2DM risk. In diabetic patients, GSTT1-null conferred higher levels of triglycerides and VLDL-cholesterol, while GSTM1-null was associated with increased levels of fasting blood glucose, glycated hemoglobin and blood pressure. We emphasized a necessity for applying log-linear analysis in order to explore an interaction between these polymorphisms properly.ConclusionThese results suggest that the GSTT1 polymorphism may play an important role in the pathogenesis of T2DM in the Brazilian population. This gene could then be added to a set of genetic markers to identify individuals with an increased risk for developing T2DM and complications associated with dyslipidemia in diabetic patients. Although there was no association of GSTM1 deletion polymorphism with susceptibility to T2DM, the influence of this polymorphism on important clinical parameters related to glycemia and blood pressure levels was verified. This finding suggests that both GSTM1-null and GSTT1-null may contribute to the clinical course of T2DM patients.

Common Carotid Artery Intima-Media Thickness Reflects the Cumulative Burden of Atherosclerosis and Predicted Well by Total-C/HDL-C Ratio in Type-II Diabetic Patients- A Case Control Study Based from Kolkata, India

Background: Diabetes Mellitus (DM) is frequently associated with the development of premature atherosclerotic vascular disease and is the major cause of morbidity and mortality. Approximately 80% of all deaths and more than 75% of all hospitalizations are due to CAD. Individuals with DM are usually associated with accelerated atherosclerosis. Common Carotid artery intima-media thickness (CCAIMT) is now also considered as a surrogate marker of atherosclerosis. Materials and Methods: This case-control study was conducted from Jan, 2011 to June, 2012 among Type-II diabetes, aged between 30-80yrs. Patients with Type-I diabetes, aged &lt;30yrs or &gt;80yrs and other secondary causes of diabetes, hypertensive, smokers and patients under therapy with lipid lowering drugs were excluded from this study. The biochemical tests were done in the department of Biochemistry, Nilratan Sarkar Medical College and Hospital, using standardized reagent kits. CCAIMT was measured by high resolution imaging using 10MHz transducer in the department of Radiodiagnosis, Nilratan Sarkar Medical College and Hospital. Results: The results of our study indicate that dyslipidemic diabetic patients had significantly higher blood glucose at any phase along with glycated haemoglobin compared to controls. The lipid variables were also significantly higher in the diabetes patients with dyslipidemia compared to controls except HDL levels were significantly higher in control. CCAIMT was higher in the dyslipidemic group (1.71 ± 0.57mm) compared to the non-dyslipidemic group (0.77 ± 0.10) which was statistically significant (p value &lt;0.001). Conclusion: CCAIMT reflects the cumulative burden of atherosclerosis and is highly correlated and predicted well by Total-C/HDL-C ratio in Type-II diabetic patients. So it is advised that a direct examination of the vessel wall is extremely essential for early detection of the affected individuals so that the cost burden in Intensive coronary care unit can be minimized and also the individual can be advised to control the extensive dyslipidemia through dietary restrictions and exercise. DOI: http://dx.doi.org/10.3126/ajms.v5i1.8450 Asian Journal of Medical Science Vol.5(1) 2014 pp.9-14

Comparison of Efficacy and Safety of Rosuvastatin, Atorvastatin and Pravastatin among Dyslipidemic Diabetic Patients

Objectives. To investigate the efficacy and the safety of the three most commonly prescribed statins (rosuvastatin, atorvastatin, and pravastatin) for managing dyslipidemia among diabetic patients in Qatar. Subjects and Methods. This retrospective observational population-based study included 350 consecutive diabetes patients who were diagnosed with dyslipidemia and prescribed any of the indicated statins between September 2005 and September 2009. Data was collected by review of the Pharmacy Database, the Electronic Medical Records Database (EMR viewer), and the Patient's Medical Records. Comparisons of lipid profile measurements at baseline and at first- and second-year intervals were taken. Results. Rosuvastatin (10 mg) was the most effective at reducing LDL-C (29.03%). Atorvastatin reduced LDL-C the most at a dose of 40 mg (22.8%), and pravastatin reduced LDL-C the most at a dose of 20 mg (20.3%). All three statins were safe in relation to muscular and hepatic functions. In relation to renal function, atorvastatin was the safest statin as it resulted in the least number of patients at the end of 2 years of treatment with the new onset of microalbuminuria (10.9%) followed by rosuvastatin (14.3%) and then pravastatin (26.6%). Conclusion. In the Qatari context, the most effective statin at reducing LDL-C was rosuvastatin 10 mg. Atorvastatin was the safest statin in relation to renal function. Future large-scale prospective studies are needed to confirm these results.

Dislipemia en población diabética tratada con estatinas. Resultados del estudio DYSIS en España

Background and objectiveType 2 diabetes mellitus (DM2) is characterized by carrying a high cardiovascular risk. This situation underscores the importance of intensively treating the risk factors present in diabetic patients, notably dyslipemia. The treatment with cholesterol-lowering drugs may be especially effective to reduce the cardiovascular risk in diabetic patients. Therefore, LDL-cholesterol is a priority target in the lipid management of these patients. This study analyzes the alterations in the lipid profile of diabetic patients receiving treatment with statins, which therefore may contribute to persistent cardiovascular risk in such individuals. Patients and MethodsThe DYSIS (Dyslipidemia International Study) is an international, observational trial analyzing the lipid profile of patients treated with statins and followed-up on in outpatient clinics by primary care physicians and specialists. This study is referred to the data on the diabetic patients. ResultsOf the total patients enrolled in the DYSIS, the present study included 3703 patients, 39% being diabetics. A total of 59.2% of diabetics showed LDL-C out of goal; triglyceride elevation was observed in 43.6% and 36.4% showed low HDL-C. In diabetics patients with coronary heart disease, 31% had uncontrolled levels of all three lipid parameters. The prevalence of out of goal LDL-C in diabetic patients with metabolic syndrome was close to 60%; 39.8% had low levels of HDL-C and 46,6% high levels of triglycerides. In addition, 57% of diabetic patients with obesity showed LDL-C out of control, despite statins treatment. ConclusionsCardiovascular diseases remain the main cause of morbidity-mortality in patients with DM2. The results of the present study show that in diabetic patients the degree of control is very limited with regard to LDL-cholesterol. More than half of diabetic patients treated with statins had LDL-cholesterol out of goal. The level of dyslipidemia control was low, despite statins treatment. Therefore, the detection of atherogenic dyslipidemia may point to the advisability of using combination therapy for dyslipidemia in diabetic patients.

Clinical evaluation of the use of statins for diabetic dyslipidaemia, especially in The Seoul Veterans Hospital

BackgroundIn diabetic patients, cardiovascular disease (CVD) is known to be the leading cause of mortality. Because dyslipidaemia can cause CVD, the management of dyslipidaemia is very important, for example by...

Therapies for diabetic dyslipidaemia

Correction of diabetic dyslipidaemia in diabetic patients is the most important factor in reducing cardiac risk. Diabetic dyslipidaemia is characterized by elevated triglycerides, low total high-density lipoprotein (HDL) and small dense low-density lipoprotein (LDL) particles. The most important therapeutic goal in diabetic dyslipidaemia is correction of the non-HDL-cholesterol (HDL-C) level. Glycaemic control with particular attention to postprandial glucose control plays a role not only in improving dyslipidaemia but also in lowering cardiac events. Pioglitazone is particularly effective for improving the manifestations of diabetic dyslipidaemia, in addition to its favorable effects on systemic inflammation and hyperglycaemia. Use of statins in addition to lifestyle change is recommended in most if not all type 2 diabetic patients and the goal should be to lower the LDL to a level recommended for the patient with existing cardiovascular disease (CVD) (non-HDL-C level <100 mg/dl). In addition, therapies for normalization of HDL and triglyceride levels should be deployed. Most patients with type 2 diabetes (T2D) will require combining a lipid-lowering therapy with therapeutic lifestyle changes to achieve optimal lipid levels. Combinations usually include two or more of the following: a statin, nicotinic acid, omega-3 fats and bile acid sequestrants (BASs). Fibrates may also be of use in diabetic patients with persistently elevated triglycerides and depressed HDL-C levels, although their role in lowering adverse CV events is questionable.

Effect of a high monounsaturated fat diet supplemented with antioxidants on dyslipidemia in type 2 diabetes in Saudi Arabia

Dyslipidemia is a common disorder associated with type 2 diabetes and is the major cause of vascular disease. Antioxidants have been shown to improve dyslipidemia. Also, a diet rich in monounsaturated fatty acids (MUFA) has been recommended for diabetic patients. The effect of a high-MUFA diet alone or with antioxidants in diabetic dyslipidemia has not been previously investigated. The aim of this study was to investigate the effect of consuming a high-MUFA diet alone or with a combination of vitamin E and C, or lycopene on dyslipidemia in diabetic patients from Saudi Arabia. Forty eight type 2 diabetic patients participated in an intervention study lasting 20 weeks divided into three 4 week intervals separated by a washout interval. Subjects consumed 35 g/day olive oil throughout the study. After the first 4 weeks, participants took vitamin E (400 mg/day) and vitamin C (1000 mg/day) supplements. After 4 weeks washout, participants consumed 45g tomato paste (12 mg lycopene/day). Fasting blood samples were analyzed for glucose, lipid profile and total antioxidant status at baseline and at the end of each interval. The high-MUFA intake alone resulted in a significant increase only in HDL-cholesterol (p<0.001). Supplementation with vitamin E and C resulted in a decrease in total, and LDL-cholesterol (p<0.001), but not in HDL-cholesterol, or triacylglycerol (TG). Lycopene consumption significantly increased HDL-cholesterol (p<0.001), with the lowest TC/HDL (p=0.002) ratio among intervals. No change in glucose, TG or TG/HDL ratio was observed at any interval. The total antioxidant status was significantly increased following a high-MUFA diet and with vitamin and lycopene supplementations. Supplementation of a high MUFA diet with vitamin E and C, or lycopene indicated a beneficial effect on dyslipidemia in type 2 diabetes.

Lowering the Triglyceride/High-Density Lipoprotein Cholesterol Ratio Is Associated With the Beneficial Impact of Pioglitazone on Progression of Coronary Atherosclerosis in Diabetic Patients: Insights From the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) Study

The purpose of this study was to determine the factors associated with the favorable effect of pioglitazone on atheroma progression. Diabetes mellitus is associated with accelerated coronary atheroma progression. Pioglitazone slowed progression compared with glimepiride in this population. In all, 360 diabetic patients with coronary artery disease were treated with pioglitazone or glimepiride for 18 months in the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) study. Coronary atheroma progression was evaluated by serial intravascular ultrasound. The relationship between changes in biochemical parameters, percent atheroma volume, and total atheroma volume was investigated. Pioglitazone-treated patients demonstrated greater increases in high-density lipoprotein cholesterol (HDL-C) and reductions in glycated hemoglobin, triglycerides, and C-reactive protein. Significant correlations were observed between changes in percent atheroma volume and triglycerides (r = 0.15, p = 0.04), triglyceride/HDL-C ratio (r = 0.16, p = 0.03), and glycated hemoglobin (r = 0.16, p = 0.03) with pioglitazone, and changes in low-density lipoprotein cholesterol (r = -0.15, p = 0.05), apolipoprotein B (r = -0.16, p = 0.04), and apolipoprotein A-I (r = -0.20, p = 0.01) with glimepiride. Substantial atheroma regression, compared to progression, was associated with greater relative increases in HDL-C (14.2% vs. 7.8%, p = 0.04), relative decreases in triglycerides (-13.3% vs. -1.9%, p = 0.045), triglyceride/HDL-C ratio (-22.5 vs. -9.9%, p = 0.05), and decrease in glycated hemoglobin (-0.6% vs. -0.3%, p = 0.01). Multivariable analysis revealed that pioglitazone-induced effects on triglyceride/HDL-C were associated with changes in percent atheroma volume (p = 0.03) and total atheroma volume (p = 0.02). Favorable effects of pioglitazone on the triglyceride/HDL-C ratio correlated with delayed atheroma progression in diabetic patients. This finding highlights the potential importance of targeting atherogenic dyslipidemia in diabetic patients with coronary artery disease.