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The atherogenic dyslipidemia ratio [log(TG)/HDL-C] is associated with residual vascular risk, beta-cell function loss and microangiopathy in type 2 diabetes females

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Atherogenic dyslipidemia (AD), defined as low HDL-C plus elevated triglycerides (TG), comorbid to T2DM, increases cardiometabolic risk for CAD even when LDL-C is at target. In T2DM males, AD was shown to correlate with β-cell function loss, yet it is not established whether this applies across gender. Aim To establish the prevalence and severity of AD in T2DM females, and to determine how it relates to cardiometabolic phenotype, glucose homeostasis, micro- and macrovascular complications, and 10-year absolute CV risk ( UKPDS Risk Engine). Methods 340 T2DM females were ranked according to quintiles (Q) of the continuous variable log (TG)/HDL-C, with AD prevalence defined as HDL-C <50 mg.dL -1 plus TG ≥150 mg.dL -1 , and β-cell function assessed with HOMA. Results AD prevalence was 35%; mean HDL-C and TG were 52 (15) and 160 (105) mg.dL -1 . AD was significantly related to central fat, metabolic syndrome, sedentarity and skeletal sarcopenia, as well as to hs CRP, fibrinogen, uric acid, cystatin-C, Big ET-1, and 10-year UKPDS CV risk. AD correlated stepwise with lower β-cell function and hyperbolic product, and with accelerated loss of residual insulin secretion, higher HbA 1c and prevalent microangiopathy. Conclusions log (TG)/HDL-C is a simple means to grade AD and residual macrovascular risk in T2DM females. This ratio associates with major non-LDL cardiometabolic variables and ranks predicted CAD risk. In addition, log (TG)/HDL-C identifies worsening glucose homeostasis, poorer glycemic control, and prevalent microangiopathy.
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Hermanset al. Lipids in Health and Disease2012,11:132 http://www.lipidworld.com/content/11/1/132
R E S E A R C HOpen Access The atherogenic dyslipidemia ratio [log(TG)/HDLC] is associated with residual vascular risk, betacell function loss and microangiopathy in type 2 diabetes females 1* 22 Michel P Hermans, Sylvie A Ahnand Michel F Rousseau
Abstract Background:Atherogenic dyslipidemia (AD), defined as low HDLC plus elevated triglycerides (TG), comorbid to T2DM, increases cardiometabolic risk for CAD even when LDLC is at target. In T2DM males, AD was shown to correlate withβcell function loss, yet it is not established whether this applies across gender. Aim:To establish the prevalence and severity of AD in T2DM females, and to determine how it relates to cardiometabolic phenotype, glucose homeostasis, micro and macrovascular complications, and 10year absolute CV risk (UKPDSRisk Engine). Methods:340 T2DM females were ranked according to quintiles (Q) of the continuous variablelog(TG)/HDLC, with 1 1 AD prevalence defined as HDLC <50 mg.dLplus TG150 mg.dL, andβcell function assessed with HOMA. 1 Results:AD prevalence was 35%; mean HDLC and TG were 52 (15) and 160 (105) mg.dL. AD was significantly related to central fat, metabolic syndrome, sedentarity and skeletal sarcopenia, as well as tohsCRP, fibrinogen, uric acid, cystatinC, Big ET1, and 10yearUKPDSCV risk. AD correlated stepwise with lowerβcell function and hyperbolic product, and with accelerated loss of residual insulin secretion, higher HbA1cand prevalent microangiopathy. Conclusions:log(TG)/HDLC is a simple means to grade AD and residual macrovascular risk in T2DM females. This ratio associates with major nonLDL cardiometabolic variables and ranks predicted CAD risk. In addition,log(TG)/ HDLC identifies worsening glucose homeostasis, poorer glycemic control, and prevalent microangiopathy. Keywords:HDLC, Triglycerides, Cardiovascular risk, Microangiopathy,βcell function, Hyperbolic product, Gender, Diabetes
Introduction Current guidelines recommend intensive lowering of low density lipoprotein cholesterol (LDLC) in type 2 diabetes mellitus (T2DM) patients [15]. The common form of T2DM, associated with insulin resistance (IR) and the metabolic syndrome (MetS) is characterized by a singular, nonLDL dyslipidemia, defined as atherogenic dyslipide mia (AD). The hallmark of AD is decreased levels of high
* Correspondence: michel.hermans@diab.ucl.ac.be 1 Division of Endocrinology and Nutrition, Université catholique de Louvain, Brussels, Belgium Full list of author information is available at the end of the article
density lipoprotein cholesterol (HDLC) together with raised triglycerides (TG). AD substantially contributes to residual vascular risk (RVR), even when LDLC is at or below targets, both in diabetic and nondiabetic popula tions. The presence and/or severity of AD can be estab lished either from thecombinedoccurrence of high TG levels and low HDLC or from theratioof fasting TG to fasting HDLC, with priorlogtransformation of TG levels allowing to compute a broad range of TG values [211]. Whereas screening for AD provides clinically relevant in formation for assessing RVR, it is rarely performed due to lack of agreement or consensual cutoffs to define/grade
© 2012 Hermans et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.