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134 Cardiovascular Risk In Diabetes: Known v/s Unknown

In this study, we found a high prevalence (81. 2 %) of is postulated to be associated with lower HDL lev-
adverse level of LDL cholesterol (over 100 mg / dL) el. Markedly lower percentages of individuals in the
at the time of diagnosis of diabetes. Although more CVD risk categories of > 10% with WHO risk score
males had LDL above 100 mg/ dL than females, no suggests the relative lack of sensitivity of including
significant gender variation was observed. Male gen- the total cholesterol level alone in predicting the CVD
der was associated with significantly higher odds of risk in Asian ethnicity.
having lower HDL cholesterol level. Males with newly
diagnosed T2DM compared to females have non-sig- Targeting Diabetic dyslipidemia with statins;
nificantly higher odds of possessing all major modifi- How about suboptimal HDL?
able CVD risk factors except higher TG level. Of the
clinical parameters, younger age at onset of diabetes Abnormalities in lipoproteins collectively named as di-
revealed a significant association with higher TG and abetic dyslipidemia augment the risk of CVD among
lower HDL cholesterol levels. BMI revealed a positive individuals with T2DM. Major components of diabet-
association with SBP, TG and low HDL but a statis- ic dyslipidemia include elevated level of triglycerides,
tically significant association of BMI was only seen small and dense low-density lipoproteins (LDL) and
9
with lower HDL cholesterol level. low levels of high-density lipoproteins (HDL) . Statin
group of drugs substantially reduce elevated LDL
cholesterol and triglycerides with favorable clinical
Cardiovascular risk assessment tools; what outcomes, but they have a marginal effect on HDL
suits us best? level .
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Risk assessment tools used to calculate the cardio- We aimed to study the prevalence of suboptimal HDL
vascular diseases risk such as the Framingham risk cholesterol level and its association with gender, in-
score (FRS), United Kingdom Prospective Diabetes dices of global and central obesity (body mass index
study (UKPDS) risk engine and the World Health Or- and waist circumference), age at onset and duration
ganization (WHO) risk score have not been tested of diabetes and glycemic control among a group of
on their ability to detect subclinical atherosclerosis patients with diabetes being followed up in a diabe-
in most developing countries .
6
tes center taking statin therapy.
We studied the associations between the calculated In this cross-sectional study we included patients
CVD risk scores using each of these tools and carot- (n=2416) taking statin group of drugs irrespective of
id intima medial thickness (CIMT), a surrogate marker the type and the dose for at least three months be-
of atherosclerosis, in a group of patients with Type 2 fore the screening visit. Association of suboptimal
diabetes (T2DM) in Sri Lanka. CVD risk scores of 68 HDL level (HDL < 40 mg/dL in males and < 50 mg/
randomly selected patients with T2DM with no his- dL in females) (dependent variable) with clinical pa-
tory or symptoms of CVD and measured their CIMT rameters (age at diagnosis and duration of diabetes,
using B mode ultrasonography. Pearson correlation gender, BMI, WC as independent variables) were
was used to study the association between CVD risk studied with logistic regression analysis.
scores with CIMT
We found that the prevalence of suboptimal HDL of
Of the 68 patients (50% males), mean age (SD), age 17.6%. Regression analysis revealed female gender,
at onset and duration of diabetes were 56.9(9.63), (OR 7.73, 95% CI 5.99 to 9.97) younger age (OR 0.98
44.26(9) and 12.16(7.6) years respectively. Of the scor- , 95% CI 0.97- 0.99 ), higher BMI (OR1.05. 95% CI 1.00
ing methods, UKPDS tool had weak, but significantly to 1.2 ) and LDL level over 100 mg / dL ( OR 1.004,
positive (r = 0.26, p < 0.05) and FRS had positive but 95% CI 1.00 to 1.007 ) have significant associations
not significant association (r= 0. 21) with CIMT. There with suboptimal HDL. (Table 4)
was a negative association between CIMT and WHO
risk score(r = - 0.07).
Conclusions
The possible explanation for both UKPDS and FRS • Several important conclusions on the CVD risks
to reveal stronger associations with a surrogate of in Type 2 diabetes among individuals in local
atherosclerosis than the WHO tool could be due to setting can be arrived from the aforementioned
inclusion of additional variables such as HDL cho- studies. They include
lesterol, HbA1c and duration of diabetes in them.
Studies have shown higher prevalence rates of lower • Testing for glucose abnormalities in patients
HDL cholesterol among Indian Asians . Higher CVD presenting with acute coronary syndrome using
7, 8
morbidity and morbidity in the South Asian region HbA1c as opposed to FPG would substantially

GCDC 2017