Plasma lipoproteins, apoproteins and cardiovascular disease in type 2 diabetic patients. A nine-year follow-up study.
OBJECTIVE
To evaluate the role of lipoprotein abnormalities as risk factors for macroangiopathy in Type 2 diabetes.


RESULTS
This prospective nine-year follow-up study involved 113 Type 2 diabetic patients (50 men and 63 women, mean age 66.9 +/- 9.9 years), 37 of whom had clinical signs of coronary heart disease (CHD) and cerebrovascular disease (CVD) at baseline. During the follow-up, 32 patients died: 17 of CHD, five of CVD, and 10 of non-vascular causes. The patients who died because of vascular disease were more frequently smokers, and had baseline symptoms of vascular disease; they were also significantly different from the other patients insofar as they were older, and had higher fasting plasma glucose levels, lower fasting C-peptide levels, and lower apoprotein (apo) AII, apo CII, apo CIII and apo E levels. Univariate analysis showed that baseline symptoms of vascular disease, current smoking, age, high fasting plasma glucose levels, low fasting C-peptide levels, and low apo AII, apo CII, apo CIII and apo E levels [but not cholesterol, triglyceride, high-density lipoprotein (HDL)-cholesterol or qualitative low-density lipoprotein or HDL abnormalities] were associated with cardiovascular mortality. Multivariate analysis showed that only age, smoking, glycated hemoglobin (HbA1c) and fasting C-peptide levels were significant independent determinants of macrovascular death.


CONCLUSIONS
In Type 2 normolipidemic diabetic patients, only age, smoking, HbA1c and fasting C-peptide levels are independent vascular risk factors. The differences in apo concentrations between patients with and without vascular disease may reflect qualitative abnormalities in plasma lipoproteins related to vascular disease.
Roselli della Rovere
G
G
Department of Medical and Surgical Sciences, University of Padova, Padova, Italy.
Lapolla
A
A
Sartore
G
G
Rossetti
C
C
Zambon
S
S
Minicuci
N
N
Crepaldi
G
G
Fedele
D
D
Manzato
E
E
D000367:Age Factors; D000368:Aged; D016633:Apolipoprotein A-II / Q000097:blood; D053304:Apolipoprotein C-II; D053305:Apolipoprotein C-III; D001056:Apolipoproteins C / Q000097:blood; D001057:Apolipoproteins E / Q000097:blood; D001059:Apoproteins / Q000097:blood*; D002096:C-Peptide / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000401:mortality; D003327:Coronary Disease / Q000150:complications / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000401:mortality; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
D016633:Apolipoprotein A-II; D053304:Apolipoprotein C-II; D053305:Apolipoprotein C-III; D001056:Apolipoproteins C; D001057:Apolipoproteins E; D001059:Apoproteins; D002096:C-Peptide; D006442:Glycated Hemoglobin; D008074:Lipoproteins