[Importance of certain hemostatic indicators as cardiovascular risk factors in type 2 diabetes]

Abnormal levels of some hemostatic factors in patients with type 2 diabetes mellitus are associated with increased risk of severe cardiovascular complications.

For the purpose of clinical practice it is necessary to specify most relevant coagulation factor abnormalities pertaining to a particular patient's risk profile (e.g. diabetes duration, his/her lipoprotein profile), since a routine examination to their full extent is in common ambulatory practice hardly manageable. This information is also needed for aiming the efforts to influence them purposefully.

The investigated group included 42 out-patients with type 2 diabetes mellitus. Selected hemostatic factors and lipoproteins were measured with standard methods. Patients were stratified into terciles based on supposedly causative factors (diabetes duration for vWF and lipoproteins for F VII), these relations being also examined in the whole group using regression analysis.

vWF (antigen) plasma concentration mean value in the whole group (in % of reference plasma: 149.917; 95% CI 134.296 to 165.538) was on the upper limit of the normal value reference range (56 to 140), exceeding it distinctly in the tercile III with the longest diabetes duration (vWF mean was 180.115; 95% CI 151.961 to 208.270). The mean in this tercile was also by 42.187 (95% CI of diff. 10.231 to 74.142; sign. level 0.012) higher than in the tercile I with the shortest diabetes duration. These 2 variables significantly correlated (r = 0.345; p = 0.025) also in the whole group. F VII plasma concentration mean values in terciles III with highest triacylglycerol (TAG) or total cholesterol (TCH) serum levels (in %: 129.286, 95% CI 121.117 to 137.455 or 121.071, 95% CI 109.228 to 132.915, respectively; the normal value reference range being 70 to 130) clearly surpassed the analogous values in tercile I by 35.0 (95% CI of diff. 22.793 to 47.207; sign. level < 10(-5)) or by 26.0 (95% CI of diff. 10.815 to 41.185; sign. level 0.002), respectively. There were also positive significant correlations between lipoproteins (TAG, TCH or LDL) and F VII in the whole group (r = 0.697, r = 0.580, r = 0.397; p < 0.0001, p < 0.0001, p = 0.018, respectively). Therefore the estimation of vWF seems to be useful in all diabetic patients and most elevated values are to be expected in long-duration-diabetics. F VII should be cared for especially in patients with concomitantly elevated TAG, TCH or LDL-cholesterol serum levels. (Tab. 6, Fig. 4, Ref. 24.)