Smoking and postprandial triglycerides are associated with vascular disease in patients with type 2 diabetes.
OBJECTIVE
To determine whether postprandial lipid levels are markers of clinical and subclinical macrovascular disease in a select group of patients with type 2 diabetes.


METHODS
We recruited 119 local patients with type 2 diabetes and moderate metabolic control (HbA1c <8%). The patients were being treated with dietary measures and/or oral antihyperglycemic therapy. No patient was receiving lipid-lowering therapy. A history of cardiovascular events was recorded and the ankle-arm index was measured to assess subclinical peripheral artery disease. The patients underwent a lipid analysis after a 12-h fast and 4h after a mixed breakfast (50 g of fat, 40 g of carbohydrates).


RESULTS
The patients with clinical and subclinical macrovascular disease had a greater history of smoking, a longer disease duration, and higher serum creatinine levels. The groups with macroangiopathy had lower postprandial concentrations of HDL cholesterol (p<0.05) and a trend towards lower fasting levels of HDL cholesterol (p=0.08) and higher fasting and postprandial levels of triglycerides (p=0.07). Multivariate analysis showed the presence of vascular (both clinical and subclinical) disease to be significantly associated with smoking (OR 3.06; 95% CI, 1.15-8.4), disease duration (for each year, OR 1.12; 95% CI, 1.03-1.22) and postprandial levels of triglycerides (for each 50mg, OR 1.73; 95% CI, 1.13-2.65).


CONCLUSIONS
In our diabetic patients, the postprandial level of triglycerides 4h after a fatty breakfast, though not fasting lipids, plus smoking and disease duration were independently associated to clinical and subclinical macrovascular disease.
Valdivielso
Pedro
P
Unidad de Lípidos, Departamento de Medicina Interna, Hospital Virgen de la Victoria, Málaga, Spain. valdivielso@uma.es
Hidalgo
Ana
A
Rioja
José
J
Aguilar
Isabel
I
Ariza
María José
MJ
González-Alegre
Teresa
T
González-Santos
Pedro
P
D000368:Aged; D001161:Arteriosclerosis / Q000150:complications*; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D008076:Cholesterol, HDL / Q000097:blood / Q000378:metabolism; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications*; D019518:Postprandial Period / Q000502:physiology; D012907:Smoking / Q000009:adverse effects*; D014280:Triglycerides / Q000097:blood*
D008076:Cholesterol, HDL; D014280:Triglycerides