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Atherogenic profiles in insulin-dependent diabetic patients and their treatment
1Department of Endocrinology-Metabolism and Clinical Nutrition, University of Antwerp 1, Belgium.
Insights
Cardiovascular disease risk is high in insulin-dependent diabetes (IDDM). Atherogenic indices reveal hidden lipoprotein abnormalities in 20-30% of IDDM patients, even with good clinical control, necessitating targeted interventions.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Disorders
Background:
- Longitudinal studies indicate significantly higher cardiovascular mortality in insulin-dependent diabetic patients (IDDM) compared to non-diabetic individuals.
- Diabetes is recognized as an independent cardiovascular risk factor, with pronounced lipid profile changes (elevated total and LDL-cholesterol, decreased HDL-cholesterol) observed in diabetic patients with existing cardiovascular disease.
Purpose of the Study:
- To evaluate lipoprotein abnormalities in IDDM patients using atherogenic indices, which consider internal lipoprotein relationships, beyond absolute criteria.
- To highlight the clinical significance of these indices in identifying pathological lipid profiles in IDDM patients, even those considered under good glycemic control.
Main Methods:
- Analysis of lipoprotein profiles in IDDM patients.
- Utilization of atherogenic indices, such as total cholesterol/HDL-cholesterol ratio and Apo A1/apo B quotient, to assess cardiovascular risk.
- Comparison of findings with absolute criteria-based assessments and data from the Diabetes Control and Complications Trial (DCCT).
Main Results:
- Standard cross-sectional studies suggest modest lipoprotein abnormalities in well-controlled IDDM.
- Application of atherogenic indices reveals pathological lipid profiles in 20-30% of IDDM patients considered to be in clinically acceptable control.
- The DCCT reported higher total cholesterol, triglycerides, and lower HDL-cholesterol in younger IDDM patients, underscoring the need for intervention.
Conclusions:
- Atherogenic indices are crucial for identifying significant lipoprotein abnormalities in IDDM patients that may be missed by conventional assessments.
- These findings emphasize the importance of diet and drug interventions for cardiovascular disease prevention, particularly in younger IDDM populations.
- Classical techniques and atherogenic profiles offer practical approaches for clinical decision-making in managing cardiovascular risk in IDDM.
Abstract:
Longitudinal studies have shown a large excess of cardiovascular mortality in insulin-dependent diabetic patients (IDDM) as compared to non-diabetic controls. Although diabetes appears to be an independent cardiovascular risk factor, increases in total and LDL-cholesterol together with a decrease of HDL-cholesterol are more pronounced in diabetics with cardiovascular disease. The general opinion, however, derived from a large number of cross-sectional studies, is that in well-controlled IDDM lipoprotein abnormalities are modest and only slightly different from matched non-diabetic controls. Most of the studies, however, used absolute criteria based on consensus statements and do not take the internal relations of the lipoproteins into account. When atherogenic indices (such as the relationship between total cholesterol and HDL-cholesterol or the Apo A1/apo B quotient) are used, 20 to 30% of an IDDM population considered to be in clinically acceptable control have to be considered pathological. This observation is even more important since the recent Diabetes Control and Complications Trial has shown that, especially in the younger group of patients, significantly higher total cholesterol and triglycerides and lower HDL-cholesterol were observed. Especially in these patients can diet and drug intervention be the most useful in the prevention of cardiovascular disease. These data are consistent with the fact that more sophisticated techniques have previously shown atherogenic changes in the composition of the VLDL-particles and lipoprotein enrichment in apo B. Since these techniques are not easily available in the clinic one has to refer to more classical techniques and the use of above mentioned atherogenic profiles to decide treatment.