A Retrospective study of Correlation of plasma Fibrinogen and Serum Lipids as risk factors for coronary artery disease in Type-2 Diabetes Mellitus

A Retrospective study of Correlation of plasma Fibrinogen and Serum Lipids as risk factors for coronary artery disease in Type-2 Diabetes Mellitus

 

I. INTRODUCTION
• Diabetes affecting nearly 200 million people world wide [Wild et al., 2004].
• Diabetes mellitus is one of the main risk factor of CAD development [NishigakiI
et al., 1981].
• CAD the first killer and the major cause of public health problems in the world
[Hadaegh et al., 2009].
II. REVIEW OF LITERATURE
• Coronary artery disease (CAD) represents - Angina pectoris,
Myocardial Infarction and sudden death [Ronald M and Krauss M
2004].
• Recent and previous studies reported DM is consider one of the main
risk factor of CAD development [Nishigaki et al., 1981].
II. REVIEW OF LITERATURE
• Fibrinogen involved increased rate of CVD in patients with Type 2 DM [Rossen
M et al., 1996].
• High fibrinogen increases high lipid profile which increase the risk of IHD in DM
than controls [J.G. Saluja et al., 2000].
• Fibrinogen in-association with Lipoprotein may play key roles in atherosclerotic
lesion formation, leads to CVD [EB Smith et al., 1992].
PROBLEM STATEMENT IN
CAMBODIA
• CHD Deaths in Cambodia 8.81%, ranks #71 in the world [WHO, 2011].
• Diabetes Mellitus Deaths in Cambodia 3.01%, ranks #72 in the world [WHO,
2011].
• Development of CAD has been increased among Type II Diabetes in Cambodian
Population.
AIM OF THE STUDY
• To address the risk factors associated with coronary artery disease in Type II
Diabetes mellitus.
OBJECTIVES OF THE STUDY
• Evaluate Type II DM with CAD and without CAD patients.
• Analyze male and female Type II diabetes with CAD and without CAD subjects.
• Evaluate ECG abnormalities of Type II DM with CAD patients.
• Compare glucose , fibrinogen and lipid profile (Cholesterol, triglycerides, HDL,
LDL and VLDL) of study Subjects.
III. MATERIALS AND METHODS
• Study Population
• Totally 100 Patients from Sen Sok International University Hospital, Phnom Penh, age
range from 35 to 75.
• Group I- 20 healthy subjects as controls
• Group II- 40 patients of Type 2 diabetes without CAD
• Group III - 40 cases of Type 2 diabetes with CAD
• Study Design
• The Retrospective study
III. MATERIALS AND METHODS
• Inclusion Criteria
• Group I
• Healthy Subjects
• Group II
• Diabetic history, family history, information on smoking and alcoholic habits.
• Group III
• Previous MI, angioplasty, coronary artery by pass grafting and had angiographic
documentation of stents.
• Exclusion Criteria
• Patients without Type-II Diabetic history, patients on drugs like glucocorticoids estrogens
and progesterone and pregnant women.
III. MATERIALS AND METHODS
• Instrumentation
• Electrocardiography
• Electrocardiogram (ECG) was recorded using CARDIPIA 400
III. MATERIALS AND METHODS
• Sample Collection
• Aseptic Blood Collection was performed
• Citrated blood centrifuged (5000 rpm) to obtain Plasma
• Coagulated blood centrifuged (5000 rpm) to obtain Serum
III. MATERIALS AND METHODS
• Fibrinogen measured
by fully automated
coagulation analyzer
Sysmex® CA-500 Series System HumaStar 600 System
Glucose and Lipid profile
analyzed using fully
automated Biochemistry
Analyzer
III. MATERIALS AND METHODS
• Estimation of Study Parameters
➢Plasma Fibrinogen [Clauss A, 1957]
➢Serum Glucose [GOD-PAP Method]
➢Serum Total Cholesterol [CHOD-PAP Method]
➢Serum Triglycerides [GPO-PAP Method]
➢Serum LDL-Cholesterol [Okada M. et al., 1998]
➢Serum HDL-Cholesterol [Gordon T et al., 1997]
➢Serum VLDL-Cholesterol [Calculated]
III. MATERIALS AND METHODS
• Statistical analysis
• Students “t” test for continuous variable and results were obtained in the form of p
(probability) value, using SPSS 16 software.
IV.
RESULTS

Gender	Control (Group I)	Diabetic without CAD (Group II)	Diabetic with CAD (Group III)
Male	13 (65%)	23 (58%)	20 (50%)
Female	7 (35%)	17 (43%)	20 (50%)
Total	20	40	40

TOTAL & GENDER WISE PERCENTAGE OF
STUDY SUBJECTS
AGE GROUP WISE DIFFERENCE AMONG TYPE-2
DIABETES WITHOUT CAD PATIENTS

Age groups in years	No. of Male cases & (%)	No. of Female cases & (%)
35-45	3 (7.5%)	5 (12.5%)
46-55	9 (22.5)	2 (5%)
56-65	4 (10%)	6 (15%)
66-75	7 (17.5%)	4 (10%)
Total	23	17

AGE GROUP WISE DIFFERENCE AMONG TYPE-2
DIABETES WITH CAD PATIENTS

Age groups in years	No. of Male cases & (%)	No. of Female cases & (%)
35-45	5 (12.5%)	7 (17.5%)
46-55	4 (10%)	3 (7.5%)
56-65	3 (7.5%)	4 (10%)
66-75	8 (20%)	6 (15%)
Total	20	20

CARDIAC PAIN CHARACTERISTICS
AMONG TYPE II DIABETES WITH CAD
PATIENTS
84%
86%
88%
90%
92%
94%
96%
98%
100%
100% 100% 100% 100%
95% 95% 95%
90% 90% 90%
Clinical symptoms
ECG CHANGES AMONG TYPE II DIABETES
WITH CAD

S. No	Gender	ST Depression (%)
1	Male (20)	100%
2	Female (20)	100%

COMPARISON OF GLUCOSE LEVELS OF
STUDY SUBJECTS

Glucose	N	Mean	StDev	P Value
Group I (Control)	20	101.55	5.0936	P<0.0001
Group II ( Diabetic without CAD)	40	202.325	46.6934	P<0.0001
Group III Diabetic with CAD	40	369.275	71.7671	P<0.0001

COMPARISON OF GLUCOSE LEVELS AMONG
MALES AND FEMALES

Control (Group I)	Diabetic without CAD (Group II)	Diabetic with CAD (Group III)
Gender	Male	Female	Male	Female	Male	Female
Glucose Mean ±SD	100.6±4.90	103.1±5.4	195.7± 53.4	211.2±35.2	359.9±60.9	378.6±81.6

P<0.0001 – Group I Vs
Group II Males & Females
P<0.0001 – Group I Vs
Group III Males & Females
P<0.0001 – Group II Vs
Group III Males & Females
COMPARISON OF FIBRINOGEN LEVEL
AMONG THREE GROUPS

Fibrinogen	N	Mean	StDev	P Value
Group I (Control)	20	284.1	37.6394	P<0.0001
Group II ( Diabetic without CAD)	40	397.625	21.1959	P<0.0001
Group III (Diabetic with CAD)	40	440.6	13.2	P<0.0001

COMPARISON OF FIBRINOGEN LEVEL AMONG
MALES AND FEMALES

Control(Group I)	Diabetic without CAD (Group II)	Diabetic with CAD (Group III)
Gender	Male	Female	Male	Female	Male	Female
Fibrinogen Mean ± SD	273.0±34.7	304.5±36.2	387.4 ± 5.1	411.4±26.6	434.6±16.0	446.65±5.1

P<0.0001 – Group I Vs
Group II Males & Females
P<0.0001 – Group I Vs
Group III Males & Females
P<0.0001 – Group II Vs
Group III Males & Females
COMPARISON OF TOTAL CHOLESTEROL
LEVEL AMONG THREE GROUPS

Total Cholesterol	N	Mean	StDev	P Value
Group I (Control)	20	173.8	11.919	P<0.0001
Group II ( Diabetic without CAD)	40	195.6	9.0718	P<0.0001
Group III Diabetic with CAD	40	228.9	36.2285	P<0.0001

COMPARISON OF TOTAL CHOLESTEROL
LEVEL AMONG MALES AND FEMALES

Control	Diabetic without CAD	Diabetic with CAD
Gender	Male	Female	Male	Female	Male	Female
Cholestero l Mean ±SD	173.1±9. 1	175±16.7	195.5±8.9	195.7±9.5	232.9±35.9	224.9±36. 9

P<0.0001 – Group I Vs
Group II Males & Females
P<0.0001 – Group I Vs
Group III Males & Females
P<0.0001 – Group II Vs
Group III Males & Females
COMPARISON OF TRIGLYCERIDE LEVEL
AMONG THREE GROUPS

Triglyceride	N	Mean	StDev	P Value
Group I (Control)	20	158.2	7.5366	P<0.0001
Group II ( Diabetic without CAD)	40	189.075	7.1302	P<0.0001
Group III Diabetic with CAD	40	210.2	27.4032	P<0.0001

COMPARISON OF TRIGLYCERIDE LEVEL
AMONG MALES AND FEMALES

Control	Diabetic without CAD	Diabetic with CAD
Gender	Male	Female	Male	Female	Male	Female
Triglyceride Mean ± SD	158.3±6.6	158±9.5	187.8±7.8	190.7±5.7	215.9±33. 6	204.5±18.4

P<0.0001 – Group I Vs
Group II Males and
Females
P<0.0001 – Group I Vs
Group III Males and
Females
P value equals 0.0004
Group II Vs Group III Males
P value equals 0.0054
Group II Vs Group III
Females
COMPARISON OF HDL LEVEL AMONG
THREE GROUPS

HDL Cholesterol	N	Mean	StDev	P Value
Group I (Control)	20	59.65	2.8335	P<0.0001
Group II ( Diabetic without CAD)	40	38.825	3.7203	P<0.0001
Group III (Diabetic with CAD)	40	27	1.1323	P<0.0001

COMPARISON OF HDL LEVEL AMONG
MALES AND FEMALES

Control (Group I)	Diabetic without CAD (Group II)	Diabetic with CAD (Group III)
Gender	Male	Femal e	Male	Female	Male	Female
HDL Mean ± SD	59.2±2.7	60.4±2.9	37.8±4.4	40.1±1.7	27.1±1.07	26.9±1.2

P<0.0001 – Group I Vs
Group II Males & Females
P<0.0001 – Group I Vs
Group III Males & Females
P<0.0001 – Group II Vs
Group III Males & Females
COMPARISON OF LDL LEVEL AMONG
THREE GROUPS

LDL Cholesterol	N	Mean	StDev
Group I (Control)	20	139.75	8.6077
Group II ( Diabetic without CAD)	40	175.775	16.4978
Group III Diabetic with CAD	40	186.3	14.0753

P<0.0001 – Group I Vs Group II
P value equals 0.0029 – Group II
Vs Group III
P<0.0001 – Group I Vs Group III
COMPARISON OF LDL LEVEL AMONG
MALES AND FEMALES

Control (Group I)	Diabetic without CAD (Group II)	Diabetic with CAD (Group III)
Gender	Male	Female	Male	Female	Male	Female
LDL Mean ± SD	138.4±8.9	142.1±7.9	180.7±4.6	169.0±23.4	189.8±14.8	182.7±12.6

P<0.0001 – Group I Vs
Group II Males and Females
P<0.0001 – Group I Vs
Group III Males and
Females
P value equals 0.0004 -
Group II Vs Group III Males
P value equals 0.0017
Group II Vs Group III
COMPARISON OF VLDL LEVEL AMONG
THREE GROUPS

VLDL Cholesterol	N	Mean	StDev	P Value
Group I (Control)	20	21.15	1.0894	P<0.0001
Group II ( Diabetic without CAD)	40	36	1.3205	P<0.0001
Group III (Diabetic with CAD)	40	42.325	2.7586	P<0.0001

COMPARISON OF VLDL LEVEL AMONG
MALES AND FEMALES

Control (Group I)	Diabetic without CAD (Group II)	Diabetic with CAD (Group III)
Gender	Male	Female	Male	Female	Male	Female
VLDL Mean ± SD	21.0 ± 1.0	21.2 ± 1.2	36±1.1	36 ± 1.5	42.3 ± 1.8	42.3 ± 3.4

P<0.0001 – Group I Vs
Group II Males & Females
P<0.0001 – Group I Vs
Group III Males & Females
P<0.0001 – Group II Vs
Group III Males & Females
V. DISCUSSION
• Male diabetic subjects were slightly higher than females in the present study.
• Recent study found 72% males and 28% were females [Khursheed et al., 2011].
• The present study observed ST segment depression among all CAD patients.
• Earlier studies also reported ST segment depression CAD cases [Menotti et al.,
1997; De Bacquer et al., 1998; Menotti et al., 2001; Larsen et al., 2002;
Knutsen et al., 1988].
V. DISCUSSION
• The present study found raised plasma fibrinogen with cardio diabetic patients.
• Several reports stated raised plasma fibrinogen positively associated with the CHD
[Lowe GDO, et al., 1997, Rosengren A, et al., 1996, Sweetnam PM, et al., 1996,
Woodward M et al., 1998, Folsom AR, et al., 1997].
V. DISCUSSION
• Present study found Increased triglycerides, total cholesterol, LDL and
VLDL and decreased HDL levels observed in type 2 diabetes.
• Previous studies reported raised serum cholesterol triglycerides, LDL,
VLDL and Low HDL levels in type 2 diabetes [Ahmad et al., 2003;
Vijay R. M and Gunaseelan. N, 2006; Shiva kumar D. G and A. R.
Patil 2005] .
VI. CONCLUSION
• The overall female Type II DM mellitus subjects are higher than male.
• There were equal number of male and female of CAD cases found among Type II
DM.
• There were more number of CAD cases observed age between 66-75 in males and
35-45 in females.
VI. CONCLUSION
• ST segment depression found among all CAD subjects.
• Significant elevation of fibrinogen and serum lipid profile among Type II diabetes
mellitus with CAD patients than without CAD and control subjects.
• Therefore, plasma fibrinogen and serum lipid profile are better markers for
inducing CAD in type 2 diabetes mellitus.
VII. RECOMMENDATION
• Regular monitoring glucose of Type II diabetes prevent Cardiac complications.
• Checking plasma fibrinogen and serum lipid profile while treating Type II
diabetes patients.
• Early Initiation of anti-diabetic, anti-thrombotic and anti-dyslipidemic agents if
the patient has hyperglycemia, hyperfibrinogenemia and dyslipidemia.
VII. RECOMMENDATION
• Proper diet and regular exercise would be beneficial for Diabetes
patients.
• Diabetes dyslipidemic patients must be cautious of eating rich
carbohydrate and fat containing foods.
• Maintaining normal serum lipid profile during Type II diabetes
mellitus can prevent CAD.

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