Title: The Study of Non-HDL Cholesterol Levels Compared to LDL Cholesterol Levels in Diabetics
Authors: Chaitanya Krishna N, Vipan Kumar Goyal, Amit Baweja, Jyoti Chakraverty, Tejesh Krishna Ch, Shobhit Shah
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.72
Abstract
Dyslipidemia is an established risk factor for CAD in patients with type II DM, as well as in nondiabetic patients, and is likely to play a leading role in the increased CVD risk associated with diabetes. If we diagnose and treat dyslipidemia in early stage, we can decrease the risk of atherosclerotic diseases. The dyslipidemia associated with type II DM is typically more complex than simple elevation of systemic low-density lipoprotein cholesterol (LDL-C) levels. Unlike LDL cholesterol, which can be incorrectly calculated in the presence of postprandial hypertriglyceridemia, NON-HDL cholesterol (Non-HDL = LDL + VLDL + IDL + Lipoprotein (a)) is reliable when measured in the non fasting state. As NON-HDL cholesterol measures the Apo B–containing lipoproteins, it can serve as an additional tool to assess cardiovascular risk in people whose risk is not accurately identified by LDL cholesterol alone. This is especially important in patients with diabetes, in whom LDL levels may not be significantly elevated. So a prospective study was carried out in 105 diabetic patients in 20 years and above age group including both sexes irrespective of community or background who were present in inpatient department of medicine, Mata Chanan Devi hospital, New Delhi, during the time period of 2014-2016. It is a 210 bedded, tertiary care hospital in west Delhi, where the patients travel from all North India. Patients with hypothyroidism, renal failure, pregnancy, hypertension, smokers and who are on lipid lowering agent were not included in the study. After taking written informed consent fasting blood sample collected from each research participant for the analysis of lipid profile. Non-HDL-C calculated as TC minus HDL-C. LDL-C calculated by direct measurement (enzymatic colour test for the quantitative determination of LDL- Cholesterol in human serum and plasma on Beckman Coulter AU analysers). National Cholesterol Education Programme Adult Treatment Panel III (NCEP-ATPIII) guidelines were referred to define dyslipidemia. The association between LDL and NON-HDL values were evaluated using the Pearson’s Chi-Squaretest. P-value <0.05 was considered statistically significant .SPSS version 20.0 was used for statistical analysis.
Salient findings Out of 105 patients, there were 56 females and 49males subjects. Minimum age is 39 years and maximum age is 81 years. Mean age in males is 56.12 ± 8.05 and in females 57.91 ± 7.13.Mean fasting blood sugar was 184.92 mg/dl and mean post prandial blood sugar was 259.58 mg/dl as patients were on treatment for diabetes. Average duration of diabetes in present study group was 5.45 years. Mean value of triglycerides, LDL, VLDL, NON HDL, HDL were 201.99, 89.58, 41.19,127.12,38.5mg/dl respectively. As per National Cholesterol Education Programme Adult Treatment Panel III (NCEP-ATPIII) guidelines for LDL the cut off value is 100mg/dl, for NON HDL the cut off value is 130mg/dl and the cut off value for difference between NON HDL and LDL is 30mg/dl in diabetics.
In this study patients who had LDL level <100mg/dl (18%) had NON HDL level >130mg/dl(28.5%) in patients with TG >200 (46.6%) Thus in patients with TG >200mg/dl most of the patients had LDL<100mg/dl but had NON HDL >130mg/dl with a significant p value 0.012.
Our study showed that the number of patients having NON HDL and LDL difference of <30mg/dl are 39(33%)and number of patients having NON HDL and LDL difference of >30mg/dl are 66(67%) with a significant P value of 0.019.That means 67% of present study patients did not had the target of <30mg/dl difference between NON HDL and LDL.
Conclusion: In our study most of the patients did not had the target of <30mg/dl difference between NON HDL and LDL. In patients with TG >200mg/dl most of the patients had LDL<100mg/dl but had NON HDL >130mg/dl. The above point clearly says that in diabetic patients with TG >200mg/dl most of the patients had the target LDL level <100mg/dl but not had the target NON HDL level <130mg/dl. Characteristic diabetic dyslipidemia pattern i.e increased TG and NON HDL but underestimated LDL is seen in most of the patients in present study. Thus we conclude that in diabetic patients when TG >200mg/dl, NON HDL is a better target than LDL in deciding treatment for dyslipidemia.
Recommendations: NON HDL is recommended as a target other than LDL for dyslipidemia in diabetics.
In diabetic patients when TG >200mg/dl, NON HDL is a better target than LDL in deciding treatment for dyslipidemia.NON HDL is better marker than LDL for starting treatment of dyslipidemia in diabetic patients to decrease cardiovascular risk. Diabetic patients who reach the target LDL level should be seen for NON HDL level in deciding treatment for dyslipidemia. Elevated levels of NON-HDL are treatable by increasing the intensity of currently available lipid lowering agents, as well as lifestyle modification. All of the currently available lipid-lowering agents (statins, fibrates, niacin, fish-oil products, and intestinally active agents) decrease non-HDL-C levels.
As we have just compared the levels of NON HDL and LDL but not assessed the cardiovascular risk and the study population is also small we suggest further more studies in making NON HDL as a better target than LDL in diabetic patients
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