title: Hypofibrinolytic State in Subjects with Type 2 Diabetes Mellitus Aggravated by the Metabolic Syndrome before Clinical Manifestations of Atherothrombotic Disease.
abstract: Background. Metabolic and genetic factors induce plasminogen activator inhibitor type-1 (PAI-1) overexpression; higher PAI-1 levels decrease fibrinolysis and promote atherothrombosis.Aim. To assess PAI-1 antigen levels among subjects with type 2 diabetes mellitus (T2DM) plus Metabolic Syndrome (MetS) before clinical manifestations of atherothrombosis and the contribution of metabolic factors and 4G/5G polymorphism of PAI-1 gene on the variability of PAI-1.Methods. We conducted an observational, cross-sectional assay in a hospital in Mexico City from May 2010 to September 2011. MetS was defined by the International Diabetes Federation criteria. PAI-1 levels and 4G/5G polymorphism were determined by ELISA and PCR-RFLP analysis.Results. We enrolled 215 subjects with T2DM plus MetS and 307 controls. Subjects with T2DM plus MetS had higher PAI-1 levels than the reference group (58.4 ± 21 versus 49.9 ± 16 ng/mL,p= 0.026). A model with components of MetS explained only 12% of variability on PAI-1 levels (R2= 0.12;p= 0.001), withβ= 0.18 (p= 0.03) for hypertension,β= -0.16 (p= 0.05) for NL HDL-c, andβ= 0.15 (p= 0.05) for NL triglycerides.Conclusion. Subjects with T2DM plus MetS have elevated PAI-1 levels before clinical manifestations of atherothrombotic disease. Metabolic factors have a more important contribution than 4G/5G polymorphism on PAI-1 plasma variability.
authors.affiliation: Servicio de Medicina Interna, UMAE Hospital de Especialidades, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.forename: Elsa
authors.initials: E
authors.lastname: Aburto-Mejía
authors.affiliation: Servicio de Urgencias, H.G.R. No. 1 "Dr. Carlos Mac Gregor Sánchez Navarro", Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.forename: David
authors.initials: D
authors.lastname: Santiago-Germán
authors.affiliation: Servicio de Neurología, UMAE Hospital de Especialidades, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.forename: Manuel
authors.initials: M
authors.lastname: Martínez-Marino
authors.affiliation: Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.lastname: María Eugenia Galván-Plata
authors.affiliation: Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Almeida-Gutiérrez
authors.affiliation: Unidad de Investigación en Nutrición Médica, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.forename: Mardia
authors.identifier: 0000-0001-8017-4390
authors.initials: M
authors.lastname: López-Alarcón
authors.affiliation: Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, H.G.R. No. 1 "Dr. Carlos Mac Gregor Sánchez Navarro", Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.forename: Jesús
authors.initials: J
authors.lastname: Hernández-Juárez
authors.affiliation: Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, H.G.R. No. 1 "Dr. Carlos Mac Gregor Sánchez Navarro", Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.forename: Antonio
authors.initials: A
authors.lastname: Alvarado-Moreno
authors.affiliation: Unidad de Investigación Médica en Medicina Reproductiva, UMAE H.G.O. No. 4, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Leaños-Miranda
authors.affiliation: Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, H.G.R. No. 1 "Dr. Carlos Mac Gregor Sánchez Navarro", Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.forename: Abraham
authors.identifier: 0000-0002-7697-5790
authors.initials: A
authors.lastname: Majluf-Cruz
authors.affiliation: Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, H.G.R. No. 1 "Dr. Carlos Mac Gregor Sánchez Navarro", Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
authors.forename: Irma
authors.identifier: 0000-0002-8986-2330
authors.initials: I
authors.lastname: Isordia-Salas
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications* / Q000235:genetics; D005260:Female; D005342:Fibrinolysis; D005787:Gene Frequency / Q000235:genetics; D005838:Genotype; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000150:complications* / Q000235:genetics; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D013927:Thrombosis / Q000097:blood* / Q000150:complications* / Q000235:genetics
chemical_list: D017395:Plasminogen Activator Inhibitor 1