Gender characteristics of lipid metabolism in patients with coronary heart disease and type 2 diabetes mellitus
AbstractHeart and metabolic diseases are very common in society today. There are many special features in their manifestation that have influence on prognosis and therapy approaches. Among them are gender characteristics. The aim of the research was to determine the gender peculiarities of disorders of lipid metabolism in patients with coronary heart disease and type 2 diabetes mellitus (T2DM). The study of the blood lipid spectrum in patients with coronary heart disease and T2DM was conducted in 72 patients aged 37 to 85 years old. The patients with coronary heart disease were divided into 2 groups depending on the presence or absence of T2DM: 1 group (n = 40) – patients with coronary heart disease only (Stable Angina Pectoris); group 2 (n = 32) – patients with coronary heart disease and T2DM. Each group was divided into subgroups depending on the gender of the patients: 1A and 2A – males, 1B and 2B – females. Despite the presence of T2DM, a majority of patients with coronary heart disease were overweight and obese. At the same time, obesity was more common in the female subgroups (1B – 45.0%, 2B – 64.7%) than in the male subgroups (1A – 35.0% and 2A – 33.3% respectively). There was an increase in the levels of total cholesterol, triglycerides and low-density lipoproteins for impaired lipid metabolism in patients with coronary heart disease. There was a slightly higher level of total cholesterol (6.12 ± 2.06 mmol/L) and low-density lipoproteins (4.24 ± 1.79 mmol/L) and a lower level of triglycerides (1.63 ± 0.65 mmol/L) in females than in males (5.15 ± 1.29, 3.71 ± 1.14 and 2.40 ± 1.06 mmol/l, respectively). Disruption of lipid metabolism was characterized predominantly by an increase in levels of triglycerides and low-density lipoproteins in blood in patients with coronary heart disease and T2DM regardless of gender. About a quarter of males (25.0% with coronary heart disease and 26.7% with coronary heart disease with T2DM) and females with T2DM (23.5%) reached the target total cholesterol level (<4.0 mmol/L), less frequently females with coronary heart disease (15.0%). The incidence of low-density lipoproteins target (<1.8 mmol/L) was significantly lower than total cholesterol: about 5.0% in males (regardless of the presence of T2DM) and 10.0% in females with coronary heart disease. Women with coronary heart disease and T2DM did not reach the target low-density lipoproteins level (<1.8 mmol/L). In most patients with coronary heart disease dyslipidemia grade II by Fredrickson was observed regardless of the presence of T2DM: in 100% of patients with coronary heart disease and 81.1% of patients with coronary heart disease and T2DM. A distinctive feature of impaired lipid metabolism in patients with coronary heart disease and T2DM is the presence in some of patients of Dyslipidemia grade IV by Fredrickson (6.7% of males and 5.9% of females) and the absence of Dyslipidemia class IIa in males in this group. Analysis of the achievement of the target levels of total cholesterol and low-density lipoproteins indicates insufficient prescribing of adequate hypolipidemic therapy for patients with coronary heart disease and T2DM.
American Diabetes Association (2018). Standards of medical care in diabetes-2018. Abridged for primary care providers. Clinical Diabetes, 36(1), 14–37.
Aschner, P. M., Muñoz, O. M., Girón, D., García, O. M., Fernández-Ávila, D. G., Casas, L. Á., Bohórquez, L. F., Arango, T. C. M., Carvajal, L., Ramírez, D. A., Sarmiento, J. G., Colon, C. A., Correa, G. N. F., Alarcón, R. P., & Bustamante, S. Á. A. (2016). Clinical practice guideline for the prevention, early detection, diagnosis, management and follow up of type 2 diabetes mellitus in adults. Colombia Medica, 47(2), 109–131.
Barrett-Connor E. (2013). Gender differences and disparities in all-cause and coronary heart disease mortality: Epidemiological aspects. Best Practice and Research. Clinical Endocrinology and Metabolism, 27(4), 481–500.
Bays, H. E., Kulkarni, A., German, C., Satish, P., Iluyomade, A., Dudum, R., Thakkar, A., Rifai, M. A., Mehta, A., Thobani, A., Al-Saiegh, Y., Nelson, A. J., Sheth, S., & Toth, P. P. (2022). Ten things to know about ten cardiovascular disease risk factors – 2022. American Journal of Preventive Cardiology, 10, 100342.
Cai, A., Li, X., Zhong, Q., Li, M., Wang, R., Liang, Y., Chen, W., Huang, T., Li, X., Zhou, Y., & Li, L. (2016). Associations of high HDL cholesterol level with all-cause mortality in patients with heart failure complicating coronary heart disease. Medicine, 95(28), e3974.
Fox, C. S., Golden, S. H., Anderson, C., Bray, G. A., Burke, L. E., de Boer, I. H., Deedwania, P., Eckel, R. H., Ershow, A. G., Fradkin, J., Inzucchi, S. E., Kosiborod, M., Nelson, R. G., Patel, M. J., Pignone, M., Quinn, L., Schauer, P. R., Selvin, E., Vafiadis, D. K., American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health, … American Diabetes Association (2015). Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: A scientific statement from the American heart association and the American diabetes association. Diabetes Care, 38(9), 1777–1803.
Fredrickson, D. S., & Lees, R. S. (1965). A system for phenotyping hyperlipoproteinemia. Circulation, 31, 321–327.
Garkusha, S., & Korzun, V. (2015). Dosvid roboty kabinetu korektsiyi lipidnoho spektra krovi ta likuvannya riznykh form ozhyrinnya u profilaktytsi vynyknennya zakhvoryuvan’ systemy krovoobihu [Experience of the functioning of the cabinet of blood lipid spectrum correction and treatment of various forms of obesity in the prevention of the diseases of cardiovascular system]. Enviroment and Health, 1, 31–34 (in Ukrainian).
Held, C., Hadziosmanovic, N., Aylward, P. E., Hagström, E., Hochman, J. S., Stewart, R. A. H., White, H. D., & Wallentin, L. (2022). Body mass index and association with cardiovascular outcomes in patients with stable coronary heart disease – a stability substudy. Journal of the American Heart Association, 11(3), e023667.
Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocrine Reviews, 37(3), 278–316.
Kindblom, J. M., Bygdell, M., Hjelmgren, O., Martikainen, J., Rosengren, A., Bergström, G., & Ohlsson, C. (2021). Pubertal body mass index change is associated with adult coronary atherosclerosis and acute coronary events in men. Arteriosclerosis, Thrombosis, and Vascular Biology, 41(8), 2318–2327.
Lehto, H. R., Pietilä, A., Niiranen, T. J., Lommi, J., & Salomaa, V. (2020). Clinical practice patterns in revascularization of diabetic patients with coronary heart disease: Nationwide register study. Annals of Medicine, 52(5), 225–232.
Liu, X., Gao, J., Chen, J., Wang, Z., Shi, Q., Man, H., Guo, S., Wang, Y., Li, Z., & Wang, W. (2016). Identification of metabolic biomarkers in patients with type 2 diabetic coronary heart diseases based on metabolomic approach. Scientific Reports, 6, 30785.
Lokpo, S. Y., Laryea, R., Osei-Yeboah, J., Owiredu, W. K. B. A., Ephraim, R. K. D., Adejumo, E. N., Ametepe, S., Appiah, M., Peter, N., Affrim, P., Kwadzokpui, P. K., & Abeka, O. K. (2022). The pattern of dyslipidaemia and factors associated with elevated levels of non-HDL-cholesterol among patients with type 2 diabetes mellitus in the Ho municipality: A cross sectional study. Heliyon, 8(8), e10279.
Mankovsky, G. B. (2018). Diagnostika narusheniy uglevodnogo obmena u bol’nykh s ishemicheskoy bolezn’yu [Diagnostics of impaired carbon metabolism in patients with ischemic heart disease]. Clinical Medicine, 23(2), 46–52 (in Russian).
Nathan, D. M., Buse, J. B., Davidson, M. B., Ferrannini, E., Holman, R. R., Sherwin, R., Zinman, B., American Diabetes Association, & European Association for Study of Diabetes (2009). Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 32(1), 193–203.
Penna, C., Andreadou, I., Aragno, M., Beauloye, C., Bertrand, L., Lazou, A., Falcão-Pires, I., Bell, R., Zuurbier, C. J., Pagliaro, P., & Hausenloy, D. J. (2020). Effect of hyperglycaemia and diabetes on acute myocardial ischaemia-reperfusion injury and cardioprotection by ischaemic conditioning protocols. British Journal of Pharmacology, 177(23), 5312–5335.
Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M. T., Corrà, U., Cosyns, B., Deaton, C., Graham, I., Hall, M. S., Hobbs, F. D. R., Løchen, M. L., Löllgen, H., Marques-Vidal, P., Perk, J., Prescott, E., Redon, J., Richter, D. J., … ESC Scientific Document Group (2016). 2016 European guidelines on cardiovascular disease prevention in clinical practice: The sixth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). European Heart Journal, 37(29), 2315–2381.
Qin, Z., Zhou, K., Li, Y. P., Wang, J. L., Cheng, W. J., Hu, C. P., Shi, C., He, H., & Zhou, Y. J. (2019). Remnant lipoproteins play an important role of in-stent restenosis in type 2 diabetes undergoing percutaneous coronary intervention: A single-centre observational cohort study. Cardiovascular Diabetology, 18(1), 11.
Raghavan, S., Vassy, J. L., Ho, Y. L., Song, R. J., Gagnon, D. R., Cho, K., Wilson, P. W. F., & Phillips, L. S. (2019). Diabetes mellitus-related all-cause and cardiovascular mortality in a national cohort of adults. Journal of the American Heart Association, 8(4), e011295.
Regitz-Zagrosek, V., & Gebhard, C. (2022). Gender medicine: Effects of sex and gender on cardiovascular disease manifestation and outcomes. Nature Reviews. Cardiology, 2022, 00797-4.
Rosenblit, P. D. (2019). Extreme atherosclerotic cardiovascular disease (ASCVD) risk recognition. Current Diabetes Reports, 19(8), 61.
Rosoff, D. B., Davey Smith, G., Mehta, N., Clarke, T. K., & Lohoff, F. W. (2020). Evaluating the relationship between alcohol consumption, tobacco use, and cardiovascular disease: A multivariable Mendelian randomization study. PLoS Medicine, 17(12), e1003410.
Rosul, M. M. (2002). Vplyv tsukrovoho diabetu 2-ho typu na perebih ishemichnoyi khvoroby sertsya [The influence of type 2 diabetes on the course of coronary heart disease]. Bukovynskyy Medychnyy Visnyk, 3, 78–80 (in Ukrainian).
Sethi, N. J., Safi, S., Korang, S. K., Hróbjartsson, A., Skoog, M., Gluud, C., & Jakobsen, J. C. (2021). Antibiotics for secondary prevention of coronary heart disease. The Cochrane Database of Systematic Reviews, 2(2), CD003610.
Stamler, J., Neaton, J. D., Cohen, J. D., Cutler, J., Eberly, L., Grandits, G., Kuller, L. H., Ockene, J., Prineas, R., & MRFIT Research Group (2012). Multiple risk factor intervention trial revisited: A new perspective based on nonfatal and fatal composite endpoints, coronary and cardiovascular, during the trial. Journal of the American Heart Association, 1(5), e003640.
Sypalo, A. O., Kravchun, P. G., & Kadykova, O. I. (2017). Rol’ sortylinu u formuvanni typiv dyslipidemiy u khvorykh na ishemichnu khvorobu sertsya ta tsukrovyy diabet 2 typu [The role of sortilin in the development of various types of dislipidemia in patients with coronary heart disease and Diabetes Mellitus 2 type]. Visnyk Vyshchoho Derzhavnoho Navchalnoho Zakladu Ukrayinska Medychna Stomatolohichna Akademiya, 17, 185–189 (in Ukrainian).
Tomic, D., Shaw, J. E., & Magliano, D. J. (2022). The burden and risks of emerging complications of diabetes mellitus. Nature Reviews. Endocrinology, 18(9), 525–539.
Wang, J., Huang, X., Fu, C., Sheng, Q., & Liu, P. (2022). Association between triglyceride glucose index, coronary artery calcification and multivessel coronary disease in Chinese patients with acute coronary syndrome. Cardiovascular Diabetology, 21(1), 187.
Ye, X., Kong, W., Zafar, M. I., & Chen, L. L. (2019). Serum triglycerides as a risk factor for cardiovascular diseases in type 2 diabetes mellitus: A systematic review and meta-analysis of prospective studies. Cardiovascular Diabetology, 18(1), 48.
Yubero-Serrano, E. M., Alcalá-Diaz, J. F., Gutierrez-Mariscal, F. M., Arenas-de Larriva, A. P., Peña-Orihuela, P. J., Blanco-Rojo, R., Martinez-Botas, J., Torres-Peña, J. D., Perez-Martinez, P., Ordovas, J. M., Delgado-Lista, J., Gómez-Coronado, D., & Lopez-Miranda, J. (2021). Association between cholesterol efflux capacity and peripheral artery disease in coronary heart disease patients with and without type 2 diabetes: From the CORDIOPREV study. Cardiovascular Diabetology, 20(1), 72.
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