SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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H. Drexel1 , S. Aczel1 , T. Marte1 , W. Benzer2 , P. Langer1 , W. Moll3 , C.H. Saely1

1Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria, 2Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria, 3Medical Central Laboratory, Feldkirch, Austria

Background: It is not clear which components of dyslipidemia predict atherosclerotic disease in diabetes type 2 (DM2) because data on lipid values in patients with both DM2 and coronary artery disease (CAD) are scarce.
Methods: We enrolled 756 consecutive patients undergoing coronary angiography for the evaluation of suspected myocardial ischemia. The incidence of vascular events was recorded during a follow-up period of 2.3 ± 0.4 years.
Results: After exclusion of patients receiving lipid lowering drugs (n = 251), coronary patients with DM2 (n = 96) had significantly higher triglycerides (191 ± 127 vs. 146 ± 86 mg/dl; p < 0.001), lower HDL-C (44 ± 13 vs. 50 ± 14 mg/dl; p < 0.001), a smaller LDL particle size (257 ± 7 vs. 260 ± 7 Å; p = 0.048), and, interestingly, lower LDL-C (124 ± 38 vs. 138 ± 33; p < 0.001) than non-diabetic patients. Factorial analysis revealed two factors in the lipid profiles of our patients: triglycerides, HDL-C, Apo A1 and LDL peak particle diameter loaded high on factor 2 (resembling the low HDL-C / high triglyceride pattern of diabetic dylipidemia), and total cholesterol, LDL-C, and Apo B loaded high on factor 1 (resembling hypercholesterolemia). In Cox regression analysis DM2 was associated with an increased risk of vascular events (n = 95), with an adjusted OR of 1.84 (1.20 - 2.82; p = 0.005). Factor 2 was significantly predictive for vascular events both in the total study population and among patients with DM2 (standardized adjusted ORs 0.74 [0.60-0.93; p = 0.009] and 1.06 [0.86-1.31; p = 0.565], respectively). Factor 1 was not significantly associated with the incidence of vascular events.
Conclusions: Levels of LDL-C are low in diabetic coronary patients. Among patients requiring coronary angiography the low HDL-C / high triglyceride pattern, but not hypercholesterolemia is predictive for vascular events. In particular, this pattern of dyslipidemia has a strong impact on the incidence of vascular events among patients with DM2.

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