W09.227 LDL cholesterol in patients with hypertriglyceridemia

Workshops W9 The metabolic syndrome coupled with the results of the Heal Protection Study has led to significant confusion as to which guidelines to adopt and led to a number of unanswered questions, e.g.: - Which lipids blood test to check? - Which patient to treat? - Should diabetics with macrovascula" disease be treated more aggressively? - Which ta'get/ta'gets to aim for? - Which lipid-lowering agent to use? Cmrently, there is no study that answers all these questions comprehensively. However, our role is to use the best available evidence based medicine to adopt a practical management guidelines that would meet the va'ious needs of all diabetics especially those with MVD. The National Service Framework requfl'es all authorities to adopt costeffective local guidelines to minimize the risk of diabetes complications. Consequently, in our region (1.5 million population), we proposed a new practical guideline (To be discussed at the congress).

•

OBESITY AS RISK FACTOR OF CVD DEVELOPMENT

E Hlubil, H. Stroitecka. Purkyn Military Medical Academy, Department of Military Hygiene, Hradec Kr lov , Czech Republic

Aims: The prevalence of the obesity as one of serious global problems is incleasing in industrialized societies. Obesity is a risk factor leading to many serious civilization diseases. It has a negative effect on the pathogenesis of ca'diovascula" diseases; diabetes mellitus type II, hypertension, dyslipidaemia. The Czech Republic ranks among the countries with the highest prevalence of dyslipoproteinaemia and ca'diovascula" diseases (CVD). Method: Otu" objective was the investigation of the change of selected anttu'opometrical and biochemical pa'ameters, especially those, which me generally used as risk indices for the origin and development of ca'diovascula" diseases: BMI, waist cfl'cumference, serum concentrations of Tchol, HDL- and LDL-cholesterol, TAG, glycated haemoglobin and homocystein during the ttu'ee-month controlled regime of weight 1eduction in obese men and women aged 25-55 yea's with BMI in the range of 30-38 kg/m 2. Results: After finishing the ta'geted weight reduction we proved that the~e is a statistically significant change in anttu'opomeU'ical and biochemical pa'ameters. BMI (%) 1st 2nd Change (%)

34,55±2,75 32,26±2,56 -6,64

T CHOL (retool/l)

LDL (retool/l)

HDL Homocyst. (retool/l) (retool/l)

5,61±0,35 3,43±0,25 1,29±0,11 13,8±6,83 5,44±0,18 3,29±0,16 1,31±0,09 13,27±3,04 -2,9 -4 1,93 -5,48

Conclusions: The results of the study proved that there is a positive effect of a ta'geted reduction diet on obese persons. Supported by IS"ojekt Podpory zdrav No 9156/2004

~ L D L

CHOLESTEROL IN PATIENTS WITH HYPERTRIGLYCERIDEMIA

J. Dvorakova, L. Dubska, J. Hyanek, L. Taborsky. Dept. Clin. Biochemistry

Hospital Na Homolce, Prague, Czech Republic Reliable measm'ement of LDL cholesterol (LDL-C) in hypertriglyceridemic samples has always been a cause of concern. Friedewald's formula (LDL-C calc) is used to estimate LDL-C fi'om total cholesterol (TC), HDL cholesterol (HDL-C) and triglyceride (TG). There ale limitations to this method (TG > 4.5 retool/l) and it is affected by the analytical en'ors of the pa'ameters used for the calculation. The dfl'ect methods do appeal" to be significantly less susceptible to interference fi'om increased TG than LDL-C calc. We introduced a dfl'ect assay for the determination of LDL-C (WAKO, Beckman Synch'on LX 20 analyser) (LDL-C dfl') in our laboratory and studied the colrelation between the results LDL-C dfl" and LDL-C calc in the control group and the group of patients with hyperlipoproteinemias. Significant differences in the mean values of both methods were observed (p < 0.0001). Mean values for LDL-C dfl" were significantly higher than those estimated by the calculation. There was no colrelation between the value of difference (LDL-C dfl" - LDL-C calc) and the value of LDL-C (Bland-Altrnan). LDL-C calc (X) significantly cola'elated with LDL-C dfl" (Y): Y = 0.9053 X + 0.8274 (r = 0.922, p < 0.0001).

Kanjuh

53

Our results confirm the underestimation of LDL-C concentration by the Friedewald's formula despite normal range of TG concentration. Dh'ect LDL-C assay is now prefered to the calculation in our laboratory.

~

PREVALENCE OF METABOLIC SYNDROME (MS) A M O N G HIV-INFECTED PATIENTS

C. Jeric , H. Knobel, M. Montero, M. Sorli, J. L pez-Colom s, J. Pedro-Botet. Hospital del Mar, Barcelona, Spain

Background. Subjects with the MS ale at increased risk for developing ca'diovascula" disease. The ATP I I I - NCEP guidelines emphasise the importance of the MS and provide diagnosis criteria. Insulim'esistance, the main cause of MS, is fi'equent among HIV patients on HAART. The aim of the plesent study was to estimate the plevalence of MS among a la'ge cohort of HIV-infected patients, and the possible relationship with HAART. Patients and method. 554 patients (407 men, 147 women) with a mean age of 42.7 -4- 9.6 yea's wele included in this cross-sectional study. 190 (34.3%) HIV-infected patients were on C clinical stage of CDC. 502 (90.6%) HIV patients were on HAART (35% PIs, 44% NNRTIs and 15% NRTIs alone). MS has been defined according to ATP I I I - NCEP criteria. A logistic-regression model was fitted to estimate the adjusted OR for the presence of SM. Results. Global prevalence of MS was 16.8%, being 17.9% and 5.8% among those receiving HAART and HIV naive patients, respectively (p= 0.03, OR: 3.57, 95% CI: 1.09-11.7). After examining all interactions, age (OR: 1.4; 95% CI: 1.1-1.8), BMI (OR: 1.4; 95% CI: 1.2-1.5), HAART (OR: 4; 95% CI: 1.1-14.8), lipodystrophy (OR: 2.2; 95% CI: 1.3-3.7), and PI exposm'e (OR: 2.1; 95% CI: 1.1-3.9) emerged as significantly and independently associated with the MS. Conclusion. The prevalence of MS is significantly increased in HIVinfected patients on HAART compa'ed with naive patients, mainly among those receiving PIs. Since MS represents a cluster of modifiable risk factors, the present results may have important implications for the health ca'e physicians.

CORONARY ARTERY DISEASE IN TYPE 2 DIABETES: CORRELATION BETWEEN M O R P H O L O G I C A L CHANGES AND METABOLIC RISK FACTORS V. Kanjuh, N.M. Lalid, M. Ostojid, K. Lalid, B. Beleslin, S. Kanjuh, A. Jotid. Institute for Cardiovascular Diseases and Institute for

Endocrinology, Belgrade, Serbia and Montenegro Objectives: The aim of this study was to compae plasma insulin (PI), plasminogen activator inhibitor 1 (PAI-1) and lipoprotein subfi'action [total cholesterol (Ch), HDL-Ch, LDL-Ch and U'iglyceride (Tg)] levels in Type 2 diabetic patients with corona'y a'tery disease (CAD) defined according to angiographically deterrnined number of stenotic corona'y a'teries (SCAs): (a) 3 SCAs (group A; N=25), (b) 2 SCAs (group B; N=30), (c) 1 SCA (group C, N=21) and (d) without SCAs (group D, N=18) Methods: The levels of PI were detected by RIA, PAI-1 by plasminogen chxomogenic plasmin substrate assay and lipoprotein subfi'actions by chxomatography. Results: We found that PI levels were significantly higher in groups A, B and C vs D (A: 29.4-4-3.7; B: 24.9-4-3.6; C: 20.1-4-4.2; D:15.1-t-2.9 mU/1, A,B,C vs D: p<0.05; A vs B vs C: p<0.05). Simila'ly, PAI-1 levels were significantly higher in groups A, B and C vs D (A: 8.3-4-1.6; B: 7.2-4-0.9; C: 6.0-t-1.3; D: 4.1-t-0.7 U/ml; A,B,C vs D: p<0.05; A vs B vs C: p<0.05). However, the lipoprotein subfi'action levels did not differ between the groups A, B and C. Also, we found that number of SCAs cola'elated significantly with PI (r=0.388, p<0.05) and PAI-1 levels (r=0.361, p<0.05). Conclusions: Our results signify that severity of CAD in type 2 diabetics, explessed by the number of SCAs detected angiographically, is associated with increases in PI and PAI-1 levels. The results imply that the severity of CAD is mainly influenced by the degree of insulin resistance and hypofibrinolysis.

74th EAS Congress, 17-20 April 2004, Seville, Spain

iiiiii..".O.'iiiiiiiiiiiiiiii

iiiii iiiiiiiiiiiiiii iiiiii.-~.'iiiiiiiiiiiiiiii