Rajmohan L, Deepa R, Mohan A, Mohan V
MV Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai.
Indian Heart J. 2000 Jul-Aug;52(4):400-6.
Very high prevalence rates of coronary artery disease have been reported among Indians. The aim of this study was to determine the relative importance of isolated hypercholesterolemia, isolated hypertriglyceridemia, isolated high low-density lipoprotein and isolated low high-density lipoprotein in coronary artery disease among South Indian type 2 diabetic subjects. The study group comprised of 17,885 type 2 diabetic patients attending our institute. A history of documented myocardial infarction was considered as the diagnostic criteria for coronary artery disease. Isolated hypercholesterolemia was defined as serum cholesterol over 200 mg/dL with normal serum triglyceride levels (< or = 200 mg/dL); isolated hypertriglyceridemia was defined as serum triglyceride level over 200 mg/dL with normal serum cholesterol levels (< or = 200 mg/dL). Isolated low high-density lipoprotein was defined as one below 35 mg/dL with normal serum triglyceride levels. Isolated high low-density lipoprotein cholesterol was defined as one over 150 mg/dL with normal serum triglyceride levels. Normolipidemia was defined as serum cholesterol and serum triglyceride both upto 200 mg/dL, high-density lipoprotein 35 mg/dL or above and low-density lipoprotein upto 150 mg/dL. The prevalence of coronary artery disease was significantly high among patients with isolated hypercholesterolemia (4.1%; p < 0.001), isolated high low-density lipoprotein (4.5%; p < 0.001) and isolated low high-density lipoprotein (3.9%; p = 0.005) compared to normolipidemic individuals (2.8%), but not in those with isolated hypertriglyceridemia (3.4%). The odds ratios for coronary artery disease increased with each quartiles of isolated cholesterol, isolated low-density lipoprotein cholesterol and total cholesterol to high-density lipoprotein ratio and reached statistical significance in the last quartile (p < 0.05). There was no significant increase in the odds ratios for coronary artery disease in relation to quartiles of isolated triglycerides. For isolated low high-density lipoprotein, when the last quartile was taken as the reference, the odds ratio for coronary artery disease in the first quartile reached statistical significance (p = 0.03). Multivariate regression analysis revealed age (odds ratio 1.06; p < 0.001), male sex (odds ratio 1.7; p < 0.001), hypercholesterolemia (odds ratio 1.26; p = 0.07) and high low-density lipoprotein levels (odds ratio 1.22; p = 0.043) to be strongly associated with coronary artery disease. Among South Indian type 2 diabetic subjects, serum isolated hypercholesterolemia and high low-density lipoprotein cholesterol but not isolated hypertriglyceridemia appear to be associated with coronary artery disease.
据报道，印度人的冠状动脉疾病患病率非常高。本研究的目的是确定在南印度2型糖尿病患者中，单纯高胆固醇血症、单纯高甘油三酯血症、单纯低密度脂蛋白升高和单纯高密度脂蛋白降低在冠状动脉疾病中的相对重要性。研究组由17885名到我院就诊的2型糖尿病患者组成。有记录的心肌梗死病史被视为冠状动脉疾病的诊断标准。单纯高胆固醇血症定义为血清胆固醇超过200mg/dL且血清甘油三酯水平正常（≤200mg/dL）；单纯高甘油三酯血症定义为血清甘油三酯水平超过200mg/dL且血清胆固醇水平正常（≤200mg/dL）。单纯高密度脂蛋白降低定义为血清甘油三酯水平正常时低于35mg/dL。单纯低密度脂蛋白胆固醇升高定义为血清甘油三酯水平正常时超过150mg/dL。正常血脂定义为血清胆固醇和血清甘油三酯均≤200mg/dL，高密度脂蛋白≥35mg/dL，低密度脂蛋白≤150mg/dL。与血脂正常的个体（2.8%）相比，单纯高胆固醇血症患者（4.1%；p<0.001）、单纯低密度脂蛋白胆固醇升高患者（4.5%；p<0.001）和单纯高密度脂蛋白降低患者（3.9%；p=0.005）的冠状动脉疾病患病率显著更高，但单纯高甘油三酯血症患者（3.4%）并非如此。冠状动脉疾病的比值比随着单纯胆固醇、单纯低密度脂蛋白胆固醇以及总胆固醇与高密度脂蛋白比值的每一个四分位数而增加，并在最后一个四分位数达到统计学显著性（p<0.05）。冠状动脉疾病的比值比与单纯甘油三酯的四分位数没有显著增加。对于单纯高密度脂蛋白降低，以最后一个四分位数为参照时，第一个四分位数的冠状动脉疾病比值比达到统计学显著性（p=0.03）。多因素回归分析显示年龄（比值比1.06；p<0.001）、男性（比值比1.7；p<0.001）、高胆固醇血症（比值比1.26；p=0.07）和低密度脂蛋白胆固醇升高水平（比值比1.22；p=0.043）与冠状动脉疾病密切相关。在南印度2型糖尿病患者中，血清单纯高胆固醇血症和低密度脂蛋白胆固醇升高似乎与冠状动脉疾病有关，而单纯高甘油三酯血症则不然。
