Lipid Profile and Coronary Heart Disease Risk in Adult Diabetic Patients in Soba University Hospital (July - December 2009)

Abstract

Diabetes mellitus is one of the main threats to human health in the twenty first century in Sudan and worldwide. Uncontrolled diabetes mellitus will be complicated by dyslipidemia which leads to serious cardiovascular events increasing diabetes morbidity and mortality. Coronary heart disease is the number one cause of death among diabetics. Despite all these facts, no study assessing coronaryheart disease risk in diabetics has been conducted in Sudan up to date. Design: Prospective hospital based cross-sectional study. Setting: Diabetes outpatient clinic in Soba University Hospital during the period from July to December 2009. Objectives: This study is conducted to determine the lipid profile patterns in adult diabetic patients in Soba University Hospital and to calculate the estimated coronary heart disease risk using Framingham scoring system. Methods: This study included 80 adult diabetic patients.Diabetic patients with other causes of dyslipidemia were excluded from the study. Eligible patients were consented, data were collected by detailed questionnaire and two blood samples were collected from each patient. The fasting lipid profile (triglyceride, total cholesterol, LDL-cholesterol and HDL-cholesterol), fasting blood glucose and the 2 hours postprandial blood glucose were measured by the auto-analyzer COBAS INTEGRA 400 plus (ROCHE). Then, for each patient we used some of the lipid profile parameters (total cholesterol, LDL-cholesterol and HDL-cholesterol) together with other Coronary heart disease risk predictors like age, smoking, blood pressure values to calculate the Coronary heart disease risk in the following 10 years using the Framingham scoring system. The data were analyzed using the MATLAB and the SPSS programs. Results: It was found that 53% of the studiedcases had diabetes mellitus chronic complications. Evidence of ischemic cardiac disease was found in 21% of the cases, mainly in type 2 patients. Hypertension was found in 29% of the cases. The studied cases showed increased body mass index, the mean was 27 kg/m 2 which represents overweight (SD 3.99). Obesity and overweight were found in 70% of the cases mostly occurring in type 2 patients. The short-termglycemic control was poor in 65% of the cases. All these markedly contributed to the poorer diabetes mellitus control, the dyslipidemia and the higher coronary heart disease risk. The lipid profile testing was requested only in 27.5% of the cases, reflecting the decreased awareness about the importance of dyslipidemia indiabetics among the medical staff who used to take care of them. The lipid profileof the studied cases was interpreted according to the National Cholesterol Education Program (NCEP) guidelines. It showed .hypertriglyceridemia in 36%, hypercholesterolemia in 31%, decreased HDL-cholesterol to levels conferring increased coronary heart disease risk in 95% and increased LDLcholesterol in 77% of the studied cases. Both type 1 and 2 diabetics had mean lipid profile values showing borderline high LDL,moderate risk HDL, normal triglyceride. The mean total cholesterol was borderline high in type 1 and desirable in type 2 patients. The lipid profile of type 1 patients isworse than that of type 2 in respect to the degree & the number of patients having the dyslipidemia. It further worsened significantly with prolonged disease duration,(P < 0.05 ). The mean estimated coronary heart disease risk in the next 10 years was 14%, which was calculated using the Framingham scoring system. This is high in comparison with low risk individuals (person the same age, optimal blood pressure, LDL-C 100-129mg/dl or cholesterol 160-199 mg/dl, HDL-C 45 mg/dl for men or 55 mg/dl for women, non-smoker, no diabetes) in whom the risk was 6%. Conclusion: According to our knowledge, it is the first time such a study is done in Sudan estimating the coronary heart disease risk in diabetics using the Framingham scoring system. The studied cases showed dyslipidemia in the form of: decreased HDLcholesterol, increased LDL-cholesterol, hypertriglyceridemia and hypercholesterolemia (in decreasing order of frequency).The lipid profile in type 1 patients was worse than type 2. The estimated coronary heart disease risk in the next 10 years was found to be remarkably high in the studied cases. These alarming findings should draw attention of health policy makers to increase the awareness about the importance of lipid profile testing in diabetics, implement coronary heart disease risk calculation and adopt a more efficient multidisciplinary team approach in diabetes management.