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Diabetic vascular disease at rest and after muscular stress
Thtowday, 27 May 1999 Poster session: The metabolic syndtr)me ncrease in blood flow in the entire study group (r = 0,47, P < 0.05). SNPnduced vasodilation did not correlate with any of the lipoprotein variables. Conclusions: Small LDL particles are. independent of LDL cholesterol :oncentration, associated with impaired h~ uit~o endothelial function. This ~ssociation provides a possible mechanism 1inking insulin resistance and he risk of developing atherosclerosis. LOW DENSITY LIPOPROTEIN SIZE IN NON INSULIN DEPENDENT DIABETIC (NIDDM) PATIENTS WITH N O R M A L rRIGLYCERIDES Vl. Fonda, A.M. Semolic, A, Petrucco, A. De Monte, M. Dapas, Vl. Malacrea, L. Santon. M. Velussi 1. L. Cattin. Atheroscle;rJsis Research
','entel; Istituto di Cliniea Aledica. Unioersita. di Trieste. Ospedale li Cattinara. Strada di Flume. 34149 Trieste; tCentro Diahetologico, 9~TJedale di Ahmlalc'one. Itah" ~lypertriglyceridemia and low HDL cholesterol are common lipid abnor-nalitics in NIDDM and are associated with small dense LDL. In a previous audy, we demonstrated an inverse relationship between LDL size and TG esponse after an oral lat load in normotriglyceridemic NIDDM patients. Fhe aim of the present study was to evaluate the prevalence of LDL pattern f3 in 172 nornlotriglyceridcmic NIDDM patients compared with 94 age-sex hatched controls. LDL size was determined by non denaturing gradient _,,el electrophoresis (I.8-16%). Pattern A was present in 60% and 40% ~f controls and NIDDM patienls, respectively, On the contrary, pattern B xas present m 20°0 of controls and 40"/0 of NIDDM patients. A slightly ,liffcrent lipoprotem profile was found between diabetic patients and controls HDL cholesterol: 505_13 vs 61±14 mg/dl, p < 0.001, NIDDM patients vs. :ontrols). In a subgroup of NIDDM patients, euglycemic insulinemic clamp ,vas perlbrnlcd, LDL size was positively related to glucose metabolized md inversely related to NEFA. The finding of a great number of NIDDM 3atients with LDL pattern B suggests that delayed postprandial lipoprotein nctabolism and postprandial atherosclerosis are remarkable problems in ~IDDM. Insulin resistance and lipid intolerance coexist in the presence ~f small dense LDL irrespectively of lasting serum triglycerides. DIABETIC VASCULAR DISEASE AT REST AND AFTER ~IUSCULAR STRESS F. Piarulli. M. Sambataro. G. Bax. D. Fedele, Portoviro (ROJ: Padua. Italy Introduction: Type 2 diabetes mellitus is linked to macrovascular disease, 9ut the pathogenesis of this complication is still unclear. The metabolic :~attern of diabetic and non diabetic microalbuminuric (AER > 20 I.tg/min) iubjects can be involved in the vascular damage and haemostatic alterations. Aim: To evaluate procoagulant markers and ankle/leg pressure Index :Winsor Index) at rest (blWI and after maximal muscular exercise (elW). Subjects: 15 diabetics with (DMI and 10 diabetics without macroangiopathy (D): 12 non diabetics with (M) and 13 controls without macroangiopathy :C) matched for age (605:1; 56+:3: 61+:2; 59+:2 aal and coronary heart disease absence: partially for BMI (285:1 vs. 30+:1 vs. 27-t-I vs. 25+:1 kg/m2) and blood pressure prevalence (60% vs. 50% vs. 40% vs. 0%1. Methods: At rest and after maximal muscular stress by Treadmill (5 km/h for 5 min with 12% of slope sec Streadness) we evaluated: a): IW with Doppler CW 4 MHz. Sound: bl: glicemia, uricemia (U) Col, TG, HDL Col, LDL, Apo B, fibrinogen (FB), trombin peptides FI + 2, trombin-antitrombin :irculating complex (TAT): c) AER {2 and 22 h after the maximal muscular ~tress). Results: blW was reduced in DM e M in relation to D and C (0.79-t-0.04 e 0.745:0.05 vs. 1,065:0.12 e 1.0345:0.13, media±SE, p < 0.0001). elW was unchanged in D and C but it was reducing in DM and still almost in M (I.065:0.14: 1.026+0.13; 0.66+:0.04 and 0.5+0.07; D and C vs. DM and M p < 0.000I; DM vs. M: p < 0.003). Col tot, LDL Col, Apo B, FB and U were significantly elevated in M versus C but not D and DM at rest and after maximal muscular stress. Basal FI + 2 were elevated in DM versus M, D and C (5.85:1.19: 2.85:0.38; 2.34+0.22; 3.3±0.73 nM/L p < 0.05): Basal TAT was elevated in DM only versus D (4.7+:0.93 vs. 2.75:0.36 nM/L p < 0.04) but not M and C (3,265:0.45; 3.13+0.65 ns vs. DM). Maximal muscular stress was able to produce a significant 0 of FI + 2 only in M (D 0.25:0.02; C 0.65:1.1 DM -1.415:1.08; ns; M 1.9:t:1,2 nM/L p < 0.026 vs. DM). Basal AER was significantly higher in DM and in M versus D and C [141+72 e 235:9 vs. 13+:6 vs. 5+1 t-tg/min p < 0.05); with more elevated logarithmic increment in C, D and DM versus M into the first 2 h after maximal muscular stress ( 1.4+0.3: 1.435:0.5:1.24:i:0.4 versus 1.0 -4- 0.4).
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Conclusions: Maximal muscular stress test induced a periferic ischemia in DM and M, but eIW reduction and trombofilic indexes elevation resulted more significant in M. In type 2 diabetes with maeroangiopathy, basal microalbuminuria and trombofilic pattern are present, but chronic metabolic complications and/or genetic changes more than per se muscular ischemia seem to be involved. VISCERAL ADIPOSE TISSUE HAS A DIFFERENT ASSOCIATION WITH CORONARY RISK FACTORS IN A POPULATION-BASED RANDOM SAMPLE OF POSTMENOPAUSAL WOMEN A. Hernandez-Ono 1, C. Posadas-Romero2, G. Monter-Carreola 3, J, Zamora-Gonzalez 2, G. Cardoso-Saldafia2, I.C. Sagrario 2. tlnstituto
Mexicano del Seguro Social." 21nstituto Nacional de Cardiologia "lgnacio Chat;ez". Mexico Visceral adipose tissue [VAT] has been considered the main determinant of the obesity-related coronary risk factors [CRF] in men and in premenopausal women. To examine VAT distribution values and their association with CRE we carried out a population-based study of a random sample of 98 postmenopausal women living in Mexico City. VAT was measured by computerized axial tomography; lipids, lipoproteins, fasting insulin and glucose, diet, smoking, physical activity and alcohol use, were also determined. When the women were divided by a cut-off point of 118 of VAT into a high (n = 74) and a low (n = 24) VAT group, the high VAT group showed higher values of trigliceride [Tg] (1725:69 vs. 127±72: p = 0.003), apolipoprotein B [apoB] (119+24 vs. 98+32; p = 0,001), glucose (120+50 vs 98+39; p = 0.026) and a higher prevalence of low high density cholesterol [HDL-C] (43 vs 16%; p < 0.05) and type 2 diabetes [DM] (28 vs. 8.3%; p < 0.05) than the low VAT group. In analizing the non hipertensive and non diabetic women [NDMHT] (n = 39), the high VAT group had similar values as the entire sample but insulin was statistically higher (8.4+8 vs. 1.9+:1; p < 0.0001 ) and HDL-C lost significance. In simple and partial correlations VAT was significantly related with total cholesterol [TC], low density lipoprotein cholesterol, Tg, apoB. glucose and insulin. HDL-C, sistolic [SBP] and diastolic blood pressure [DBP] showed no significant correlations with VAT. Multiple regression analysis in the [NDMHT] women showed that VAT explained 14.6, 20.2, and 32.7% of the variation of heart rate [HR], insulin and glucose, respectively. In conclusion, in this population-based random sample of postmenopausal women, VAT was associated with higher values o f T g , apoB, insulin and HR as well as a higher prevalence of high TC, low HDL-C, and DM. Our data is different from other reports because HDL-C, SBP and DBP showed no significant correlations with VAT. The difference may be given in part by the random nature of the selection method used in this study. LOW DENSITY LIPOPROTEIN PARTICLE SIZE IS NOT INDEPENDENTLY ASSOCIATED W I T H VISCERAL ADIPOSE TISSUE IN A POPULATION-BASED RANDOM SAMPLE OF POSTMENOPAUSAL W O M E N C. Posadas-Romerol., J. Zamora-Gonzalez 1, A. Hernandez-Ono 2, M. Cruz-Gomez, G. Cardoso-Saldafia 1 . tlnstituto Nacional de Cardiologia
"lgnacio Chavez'; -Instttnto Mexicano del Seguro Social. Merico Low density lipoprotein [LDL] particles show a considerable variation in their size, density and chemical composition. People with a predominance of small LDL particle size [LDLps] appear to be at increased risk for coronary artery disease. To date, no study has associated LDLps with visceral adipose tissue [VAT] in postmenopausal women [PMW]. To examine the association between LDLps and VAT values as well as other coronary risk factors, we carried out a population-based study of a random sample of 98 PMW living in Mexico City. VAT was measured by computerized axial tomography; lipids, lipoproteins, fasting insulin and glucose, diet smoking, physical activity and alcohol use, were also determined. LDLps was determined by nondenaturating polyacrylamide gradient gel electrophoresis. The sample had 74 PMW with either type 2 diabetes or hypertension [DMHT] and 39 PMW without these diseases [NDMHT]. The DMHT group did not have significant differences in lipid and lipoprotein plasma values when compared with the NDMHT group. However, LDLps was smaller (26.14-1-1.1 vs. 27.18+0.1; p < 0.0001) and prevalence of pattern B (<25.5 nm) was higher (36.2 vs 5.1%; p = 0.0004) in the DMHT group, in the NDMHT group LDLps was positively correlated to high density lipopoprotein cholesterol [HDL-C] (0.42; p = 0.009) and inversely correlated with total cholesterol (-0.38; p = 0.019), LDL cholesterol [LDL-C] (-0.37; p = 0.023), triglyceride [LnTg] (-0.69; p = 0.0001), apolipoprotein B [apoB] (-0.49; p = 0.002),
71st EAS Congress and Satellite S),mposia
i
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','entel; Istituto di Cliniea Aledica. Unioersita. di Trieste. Ospedale li Cattinara. Strada di Flume. 34149 Trieste; tCentro Diahetologico, 9~TJedale di Ahmlalc'one. Itah" ~lypertriglyceridemia and low HDL cholesterol are common lipid abnor-nalitics in NIDDM and are associated with small dense LDL. In a previous audy, we demonstrated an inverse relationship between LDL size and TG esponse after an oral lat load in normotriglyceridemic NIDDM patients. Fhe aim of the present study was to evaluate the prevalence of LDL pattern f3 in 172 nornlotriglyceridcmic NIDDM patients compared with 94 age-sex hatched controls. LDL size was determined by non denaturing gradient _,,el electrophoresis (I.8-16%). Pattern A was present in 60% and 40% ~f controls and NIDDM patienls, respectively, On the contrary, pattern B xas present m 20°0 of controls and 40"/0 of NIDDM patients. A slightly ,liffcrent lipoprotem profile was found between diabetic patients and controls HDL cholesterol: 505_13 vs 61±14 mg/dl, p < 0.001, NIDDM patients vs. :ontrols). In a subgroup of NIDDM patients, euglycemic insulinemic clamp ,vas perlbrnlcd, LDL size was positively related to glucose metabolized md inversely related to NEFA. The finding of a great number of NIDDM 3atients with LDL pattern B suggests that delayed postprandial lipoprotein nctabolism and postprandial atherosclerosis are remarkable problems in ~IDDM. Insulin resistance and lipid intolerance coexist in the presence ~f small dense LDL irrespectively of lasting serum triglycerides. DIABETIC VASCULAR DISEASE AT REST AND AFTER ~IUSCULAR STRESS F. Piarulli. M. Sambataro. G. Bax. D. Fedele, Portoviro (ROJ: Padua. Italy Introduction: Type 2 diabetes mellitus is linked to macrovascular disease, 9ut the pathogenesis of this complication is still unclear. The metabolic :~attern of diabetic and non diabetic microalbuminuric (AER > 20 I.tg/min) iubjects can be involved in the vascular damage and haemostatic alterations. Aim: To evaluate procoagulant markers and ankle/leg pressure Index :Winsor Index) at rest (blWI and after maximal muscular exercise (elW). Subjects: 15 diabetics with (DMI and 10 diabetics without macroangiopathy (D): 12 non diabetics with (M) and 13 controls without macroangiopathy :C) matched for age (605:1; 56+:3: 61+:2; 59+:2 aal and coronary heart disease absence: partially for BMI (285:1 vs. 30+:1 vs. 27-t-I vs. 25+:1 kg/m2) and blood pressure prevalence (60% vs. 50% vs. 40% vs. 0%1. Methods: At rest and after maximal muscular stress by Treadmill (5 km/h for 5 min with 12% of slope sec Streadness) we evaluated: a): IW with Doppler CW 4 MHz. Sound: bl: glicemia, uricemia (U) Col, TG, HDL Col, LDL, Apo B, fibrinogen (FB), trombin peptides FI + 2, trombin-antitrombin :irculating complex (TAT): c) AER {2 and 22 h after the maximal muscular ~tress). Results: blW was reduced in DM e M in relation to D and C (0.79-t-0.04 e 0.745:0.05 vs. 1,065:0.12 e 1.0345:0.13, media±SE, p < 0.0001). elW was unchanged in D and C but it was reducing in DM and still almost in M (I.065:0.14: 1.026+0.13; 0.66+:0.04 and 0.5+0.07; D and C vs. DM and M p < 0.000I; DM vs. M: p < 0.003). Col tot, LDL Col, Apo B, FB and U were significantly elevated in M versus C but not D and DM at rest and after maximal muscular stress. Basal FI + 2 were elevated in DM versus M, D and C (5.85:1.19: 2.85:0.38; 2.34+0.22; 3.3±0.73 nM/L p < 0.05): Basal TAT was elevated in DM only versus D (4.7+:0.93 vs. 2.75:0.36 nM/L p < 0.04) but not M and C (3,265:0.45; 3.13+0.65 ns vs. DM). Maximal muscular stress was able to produce a significant 0 of FI + 2 only in M (D 0.25:0.02; C 0.65:1.1 DM -1.415:1.08; ns; M 1.9:t:1,2 nM/L p < 0.026 vs. DM). Basal AER was significantly higher in DM and in M versus D and C [141+72 e 235:9 vs. 13+:6 vs. 5+1 t-tg/min p < 0.05); with more elevated logarithmic increment in C, D and DM versus M into the first 2 h after maximal muscular stress ( 1.4+0.3: 1.435:0.5:1.24:i:0.4 versus 1.0 -4- 0.4).
59
Conclusions: Maximal muscular stress test induced a periferic ischemia in DM and M, but eIW reduction and trombofilic indexes elevation resulted more significant in M. In type 2 diabetes with maeroangiopathy, basal microalbuminuria and trombofilic pattern are present, but chronic metabolic complications and/or genetic changes more than per se muscular ischemia seem to be involved. VISCERAL ADIPOSE TISSUE HAS A DIFFERENT ASSOCIATION WITH CORONARY RISK FACTORS IN A POPULATION-BASED RANDOM SAMPLE OF POSTMENOPAUSAL WOMEN A. Hernandez-Ono 1, C. Posadas-Romero2, G. Monter-Carreola 3, J, Zamora-Gonzalez 2, G. Cardoso-Saldafia2, I.C. Sagrario 2. tlnstituto
Mexicano del Seguro Social." 21nstituto Nacional de Cardiologia "lgnacio Chat;ez". Mexico Visceral adipose tissue [VAT] has been considered the main determinant of the obesity-related coronary risk factors [CRF] in men and in premenopausal women. To examine VAT distribution values and their association with CRE we carried out a population-based study of a random sample of 98 postmenopausal women living in Mexico City. VAT was measured by computerized axial tomography; lipids, lipoproteins, fasting insulin and glucose, diet, smoking, physical activity and alcohol use, were also determined. When the women were divided by a cut-off point of 118 of VAT into a high (n = 74) and a low (n = 24) VAT group, the high VAT group showed higher values of trigliceride [Tg] (1725:69 vs. 127±72: p = 0.003), apolipoprotein B [apoB] (119+24 vs. 98+32; p = 0,001), glucose (120+50 vs 98+39; p = 0.026) and a higher prevalence of low high density cholesterol [HDL-C] (43 vs 16%; p < 0.05) and type 2 diabetes [DM] (28 vs. 8.3%; p < 0.05) than the low VAT group. In analizing the non hipertensive and non diabetic women [NDMHT] (n = 39), the high VAT group had similar values as the entire sample but insulin was statistically higher (8.4+8 vs. 1.9+:1; p < 0.0001 ) and HDL-C lost significance. In simple and partial correlations VAT was significantly related with total cholesterol [TC], low density lipoprotein cholesterol, Tg, apoB. glucose and insulin. HDL-C, sistolic [SBP] and diastolic blood pressure [DBP] showed no significant correlations with VAT. Multiple regression analysis in the [NDMHT] women showed that VAT explained 14.6, 20.2, and 32.7% of the variation of heart rate [HR], insulin and glucose, respectively. In conclusion, in this population-based random sample of postmenopausal women, VAT was associated with higher values o f T g , apoB, insulin and HR as well as a higher prevalence of high TC, low HDL-C, and DM. Our data is different from other reports because HDL-C, SBP and DBP showed no significant correlations with VAT. The difference may be given in part by the random nature of the selection method used in this study. LOW DENSITY LIPOPROTEIN PARTICLE SIZE IS NOT INDEPENDENTLY ASSOCIATED W I T H VISCERAL ADIPOSE TISSUE IN A POPULATION-BASED RANDOM SAMPLE OF POSTMENOPAUSAL W O M E N C. Posadas-Romerol., J. Zamora-Gonzalez 1, A. Hernandez-Ono 2, M. Cruz-Gomez, G. Cardoso-Saldafia 1 . tlnstituto Nacional de Cardiologia
"lgnacio Chavez'; -Instttnto Mexicano del Seguro Social. Merico Low density lipoprotein [LDL] particles show a considerable variation in their size, density and chemical composition. People with a predominance of small LDL particle size [LDLps] appear to be at increased risk for coronary artery disease. To date, no study has associated LDLps with visceral adipose tissue [VAT] in postmenopausal women [PMW]. To examine the association between LDLps and VAT values as well as other coronary risk factors, we carried out a population-based study of a random sample of 98 PMW living in Mexico City. VAT was measured by computerized axial tomography; lipids, lipoproteins, fasting insulin and glucose, diet smoking, physical activity and alcohol use, were also determined. LDLps was determined by nondenaturating polyacrylamide gradient gel electrophoresis. The sample had 74 PMW with either type 2 diabetes or hypertension [DMHT] and 39 PMW without these diseases [NDMHT]. The DMHT group did not have significant differences in lipid and lipoprotein plasma values when compared with the NDMHT group. However, LDLps was smaller (26.14-1-1.1 vs. 27.18+0.1; p < 0.0001) and prevalence of pattern B (<25.5 nm) was higher (36.2 vs 5.1%; p = 0.0004) in the DMHT group, in the NDMHT group LDLps was positively correlated to high density lipopoprotein cholesterol [HDL-C] (0.42; p = 0.009) and inversely correlated with total cholesterol (-0.38; p = 0.019), LDL cholesterol [LDL-C] (-0.37; p = 0.023), triglyceride [LnTg] (-0.69; p = 0.0001), apolipoprotein B [apoB] (-0.49; p = 0.002),
71st EAS Congress and Satellite S),mposia
i
-r C 7~ ¢1 C