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International Journal of Pharma and Bio Sciences

NON-HDL CHOLESTEROL AND LDL-C/HDL-C RATIO IN TYPE II DIABETIC

PATIENTS

INDUMATI.V* 1, VIDYA.S.PATIL 2, KRISHNASWAMY.D 3, SATISHKUMAR.D 4,VIJAY.V 5, MAHESH.S 6, RAJESHWARI.V 7

1,3,4,5,6,7 Department of Biochemistry,Vijaynagar Institute of Medical Sciences, Bellary, Karnataka;2 Department of Biochemistry, SDMCMS, Dharwad, Karnataka.

*Corresponding author

RESEARCH ARTICLE BIO CHEMISTRY

ABSTRACT

Diabetic dyslipidemia consists of elevated LDL cholesterol, Triglycerides and decreasedlevels of HDL Cholesterol. More recent data suggests that measurement of Non -HDLCholesterol level (calculated as Total Cholesterol minus HDL Cholesterol) could be morerepresentative of all atherogenic, apolipoprotein (apo) B containing lipoproteins. Althoughapolipoprotein B can be assessed directly, measurement of Non-HDL Cholesterol can beconsidered as a surrogate marker for apolipoprotein B in routine clinical practice. Here anattempt is to evaluate the Lipid profile including Non-HDL Cholesterol levels and LDL-C/HDL-C ratio in type II Diabetic Patients as markers of diabetic dyslipidemia.

Our study group comprised of age and sex matched 50 normal, 50 type II diabeticsubjects. There was a significant increase in Non-HDL cholesterol (p

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KEY WORDS

Atherogenic lipoproteins, Diabetic Dyslipidemia, LDL-C/HDL-C ratio, Non-HDL Cholesterol.

INTRODUCTION

In India, diabetes is not an epidemic anymorebut has turned into a pandemic.According tothe International Journal of Diabetes indeveloping Countries which labeledIndia as the diabetic capital of the world. TheInternational Diabetes Federation estimatesthat the number of diabetic patients in Indiamore than doubled from 19 million in 1995 to40.9 million in 2007. It is projected to increaseto 69.9 million by 2025.Type II diabetes and its

complications constitute a ajor worldwidepublic health problem. Patients with type IIdiabetes have 2 - 4 times higher risk of experiencing cardiovascular disease(CVD)than adults without diabetes 1,2 and their relative risk of ying from CVD is about twice ashigh 3, much of which may be preventable withappropriate treatment of dyslipidemia.

The elevated CVD risk affecting patientswith Type II diabetes may be attributed to acombined dyslipidemia characterised by

elevated triglycerides, elevated triglyceride richremnant lipoproteins(TGRLP), elevatedapolipoprotein (apo) B and low levels of HDLcholesterol, with a predominance of small,dense LDL particles amid relatively normal LDLCholesterol levels 4. More recent data suggeststhat measurement of Non -HDL Cholesterollevel (Calculated as Total Cholesterol minusHDL Cholesterol) could be more representativeof all atherogenic, apolipoprotein (apo) Bcontaining lipoproteins LDL,VLDL,IDL and

Lipoprotein(a). Although apolipoprotein B canbe assessed directly, measurement of Non-HDL Cholesterol is more practical, reliable,inexpensive and can be considered as asurrogate marker for apolipoprotein B in routineclinical practice 5,6 . Hence in the present studyan attempt is made to study Non-HDLCholesterol levels as a marker of dyslipidemiain diabetic patients.

Materials: The Institutional Ethical Committeeapproved the study and informed consent wasobtained from each participant in the study.Our study group comprised of age matched 50normal, 50 type II diabetic subjects in malesand 50 normal and 50 type II diabetic subjectsin females.

Inclusion Criteria: Only old cases of Type IIDiabetic subjects with fasting glucose above

126mg/dl and glycosylated hemoglobin(HbA 1c )levels > 6% were considered as per therecommendations of American diabeticassociation(ADA).

Exclusion criteria: Type II Diabetic patientson hypolipidemic drugs were excluded from thestudy. Patients with thyroid disorders andobstructive liver disorders also were excludedfrom our study group.

All participants underwent complete physical

examination including measurement of heightand weight. BMI was calculated as weight inkilograms divided by height in squared meters.

Methods: 12 hours fasting venous blood wascollected from antecubital vein under asepticprecautions. 2 ml blood was allowed to clot andserum was separated by centrifugation andstored at 4 0C. The estimation was carried outwithin 6-8 hours. Another 2 ml blood wascollected in a bulb containing EDTA for

estimation of Glycosylatedhemoglobin(HbA1c).The Parameters studied were: Glucose byGOD-POD method , Total Cholesterol byCHOD-PAP method, Triglyceride By GPOmethod, HDL Cholesterol by Phosphotungstatemethod, LDL Cholesterol was calculated byFriedwald et al formula(LDLCholesterol(mg/dl)= Total Cholesterol (HDLCholesterol + Triglycerides/5) , Non-HDL

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There was a significant increase in Total Cholesterol (p

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needed. At present such evidence is not yetavailable. One of the studies has concludedthat both Non-HDL cholesterol and apo-B aremore potent predictors of CVD incidenceamong diabetic men than LDL Cholesterol 14 .

The Adult Treatment Panel (ATP) III of the National Cholesterol Education Program

(NCEP) has recommended that Non-HDLcholesterol be used as a secondary target of therapy in people with Triglyceride levels >200mg/dl, especially those with diabetes or metabolic syndrome 16 .

Comparison of LDL Cholesterol and Non-HDL Cholesterol Goals for Three Risk Categories 16 Risk Category LDL Goal(mg/dl) Non-HDL Goal(mg/dl)

CHD and CHD Risk Equivalent(10- year RiskFor CHD > 20%)

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which involved almost 15,000 men ages 40 to84 years, a 1-unit increase in the LDL-C/HDL-C ratio was associated with a 53% increase inrisk of MI 20 . In the Boston Area Health Study,which analyzed a group of men and womenless than 76 years of age with no prior historyof CVD but who had experienced a first MI, a1-unit increase in the LDL-C/HDL-C ratio wasassociated with a 75% increase in risk of MI 21 .In addition, comparison of individual LDL-C/HDL-C ratios from subjects in theFramingham Study clearly indicates that theratios are significantly more robust predictorsof CVD than the individual levels of LDL-C or HDL-C . The existing focus on LDL-C as theprimary culprit in atherogenesis may divertattention from the more efficient lipid profile of LDL-C/HDL-C ratio. The LDL-C/HDL-C ratioreflects the two-way traffic of cholesterol

entering and leaving the arterial intima in a waythat the individual levels of LDL-C and HDL-Cdo not 22 .

CONCLUSION

Careful analysis of the lipid profile can make asignificant difference in reducingcardiovascular risk. As Non-HDL Cholesterol ismore representative of all atherogeniclipoproteins, more emphasis should be placedon considering Non-HDL cholesterol and LDL-C/HDL-C ratio as markers of Diabeticdyslipedemia than LDL Cholesterol alone.Further prospective follow up studies areneeded to study the Non-HDL Cholesterollevels in comparison to apolipoprorein B as apredictor of CVD in Type II Diabetic patients.

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