| dc.description.abstract | Background: Diabetes Mellitus (DM) is associated with significant mortality and morbidity which are far worse in the developing countries than elsewhere. Vascular diseases in DM account for the majority of deaths in diabetics. Dyslipidaemia is a major potential modifiable risk factor for the macrovascular complications in diabetics. In DM, abnormalities in lipid and lipoprotein metabolism occur mainly due to insulin resistance and/or insulin deficiency. Diabetic dyslipidaemia consists of a characteristic pattern characterized by high plasma triglycerides, low high density lipoprotein cholesterol (HDL-C) and increased concentrations of small dense low density lipoprotein cholesterol (LDL-C) particles which are all atherogenic. A routine lipid profile does not accurately assess the presence of small dense low density cholesterol particles. Apolipoprotein B (apo B) is the principal lipoprotein moiety of very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL), lipoprotein a (Lpa) and both large buoyant and small dense LDL and therefore more accurately assess the cardiovascular disease risk. This study aimed at assessing the correlation between apo B and the routine lipid profile as markers of cardiovascular risk in type 2 diabetic patients at outpatient diabetic clinic of Kenyatta National Hospital.
Study objectives: The main objective of the study was to assess the correlation between apolipoprotein B and lipid profile as markers of cardiovascular disease risk in type 2 diabetic patients attending the outpatient diabetic clinic of Kenyatta National Hospital. Methods and materials: The study was a descriptive cross-sectional study carried out in the diabetic clinic of Kenyatta National Hospital in Nairobi, Kenya. The study population consisted of type 2 diabetic patients. Ninety six type 2 diabetic patients not on lipid-lowering drugs were examined and the following parameters were taken: blood pressure, weight and height. Body mass index and waist to hip ratio were calculated. Metabolic syndrome was defined by the presence of three of the following parameters: diabetes, hypertension, dyslipidaemia and central obesity. Blood samples were then drawn and analyzed for total cholesterol, LDL-C, HDL-C and triglycerides and apolipoprotein B using Humastar 600® Biochemical analyser. The final concentration of the analytes was determined by measurement of the absorbance of the final product after an enzymatic reaction. Data management and analysis: Demographic, medical history, physical examination and laboratory analysis data was collected using a structured questionnaire. The data was coded, entered in SPSS work sheet cleaned for confounders and analysed using SPSS version 18.0. The 5% level of significance (95% confidence interval) with p-values of <0.05 was considered statistically significant. Results: Of the 96 patients were studied, 60.7% were females. The age range was 33-88yr with mean of 59.5yr and a median of 60yr. Eighty percent(80%) of the patients studied had low HDL-C (<1.35mmol/L), 74.5% had high total cholesterol (> 4.38mmol/L), 71.3% had high triglycerides (> 1.05mmol/L), 69.1% had high LDL-C (> 2.49mmol/L), 78.7% had high non-HDL-C (>3.03mmol/L) and 61.7% had high apo B (>0.65g/L). The most frequent lipid disorder was low HDL-C with the least frequent being high apo B. There was a strong positive correlation between apo B and non-HDL-C (p value < 0.001). In addition, 20.7% of patients with normal total cholesterol had high apo B and 22.4% of patients with normal triglycerides had high apo B. Further, 27.6% of patients with normal LDL-C had high apo B. The mean body mass index (kg/m²) of females was 29.7 and 27.7 for males. The mean waist to hip ratio for males was 0.99 and that of females 0.91. Seventy four percent (74%) of the patients studied had metabolic syndrome. Conclusion and Recommendations: A significant proportion of the patients studied had dyslipidaemia cutting across all the parameters. Apo B has helped identify additional dyslipidaemia phenotypes in patients with normal total cholesterol and normal LDL-C. Non-HDL-C should routinely be calculated for type 2 diabetic patients to aid in cardiovascular risk assessment since it measures total atherogenic potential that may be missed by LDL-C | en_US |
| dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
