Association of coronary heart disease with serum lipid and apolipoprotein concentrations in long-term diabetes. Results of the Erfurt study.

The Erfurt study is concerned with the follow-up of all the 208 long-term diabetics out of the closed area of the Erfurt district with an at least 20 years' diabetes survival in 1970. In 1980 risk factors for coronary heart disease (CHD) were assessed in 71 (85% type I diabetes) out of 76 patients still alive. Progression of CHD within the subsequent five years (death due to CHD in 8 cases and progression of the ECG findings according to the Minnesota code in 3 cases) was associated with older age, lower body mass index, higher triglycerides, and a higher total cholesterol/HDL cholesterol ratio in comparison with the surviving patients without progression (n = 41). No significant differences could be found with regard to sex distribution, age at diabetes onset, duration of diabetes, percentage of type I diabetes, systolic and diastolic blood pressure, smoking behavior, prevalence of nephropathy, glycemic control, and serum levels of total cholesterol, LDL cholesterol, and HDL cholesterol. The subsequent reinvestigation in 1985 also included the determination of apolipoproteins. Since type II diabetes was not equally distributed, only type I diabetics were considered for the comparison of patients with ECG findings suggestive of CHD (n = 5) with the remaining subjects (n = 35). In addition to the above mentioned differences, CHD in long-term type I diabetes was also accompanied by lower HDL cholesterol, lower apolipoprotein A-I, and a higher apolipoprotein B/apolipoprotein A-I ratio. Substantially similar differences could be observed when type II diabetics were not excluded (10 patients with and 37 patients without CHD). It is concluded that the lipoprotein pattern is important for the survival in long-term diabetes.