The Relations Between Postprandial Triglyceridemia And Lower Extremity Arterial Disease In Type 2 Diabetes Subjects

PrefaceMore and more studies demonstrated that macrovascular disease of Type 2 diabetes is frequently associated with abnormalities in lipoprotein metabolism. In 1979,Zilversmit proposed the the postprandial accumulation of triglyceride-rich lipoproteins resulted from a reduction in the rate of clearance of the triglyceride-rich dietary remnant particles at the endothelial surface and promoted the development of atherosclerosis. Associations between atheroslerotic diseases and elevated fasting plasma lipid are well established. Various reports have provided evidence of a relation between postprandial lipemia and macrovascular artery disease. To our knowledge there is little information in the literature similarly relating postprandial hypertriglyceridemia to lower extremity arterial disease in Type 2 diabetes. Postprandial TRL levels are elevated In type 2 diabetes . This occurs even when fasting triglyceride levels are normal. People are predominantly in a postprandial state throughout the day. Most studies of lipoprotein metabolism in T2DM, however, have focused on the fasting state. Blood lipid alterations after a fatty meal may be atherogenic , but there is little information regarding their associations with Lower extremity arterial disease of diabetes patients ( LEAD-DP) independent of fasting lipids.MATERAL AND METHODSixty-six subjects were studied in this program . The subjects were divided into two groups; the cases group with LEADDP and the control group without LEADDP. Common characters were recorded such as sex, age, duration, hy-pertension and smoking status . The subjects ate just like they did as usual . All subjects were measured the height, weight, BMI, fasting blood glucose, fasting TG, fasting TC, HDL-C, LDL-C and fasting insulin level. Blood samples were obtained 2 hours after each meals, then the average lipid, postprandial glucose and insulin level were calculated. Each subject underwent an ultrasound examination of lower extremity artery. Statistics data was conducted by SPSS program. Independent t test between two groups and multivariate regression techniques were used to test the hypothesis.RESULTSWithin each group cases and control subjects were similar with respect to sex , age, BMI, smoking status ,hypertension ,fasting lipid level and fasting blood glucose. Compared with control subjects, the cases with LEADDP had significantly higher mean postprandial TG and Lower HDL-C (P <0. 01) ; Among control group there were no significant difference between fasting and postprandial TG and HDL-C (P >0. 05). In cases ,TG levels rose from a fasting mean of 2. 17 0. 90 mmol/L to 3. 99 5.40 mmol/L at 2 hours after the meals . HDL-C levels reduced from a fasting mean of 1. 13 0. 19 mmol/L to 1. 14 0. 13 mmol/L at 2 hour after the meals. For both TG and HDL-C the levels were significantly different in cases than in control subjects . No significant difference for postprandial TC and LDL-C were found in each group. Independent associations of postprandial TG were evaluated in analyses the controlled for fasting TG and other risk factors, such as age, sex, duration, BMI, smoking status, hypertension , insulin level. Multivariate regression resulted in the inclusion, that a significant correlation existed between the postprandial TG and macrovascular complication.CONCLUSIONTriglyceride in the postprandial state are significantly elevated in subjectswith lower extremity arterial disease in T2DM. Elevated postprandial TG appears to be an independent risk factor for LADDP disease in T2DM. It may be suitable for the patients with postprandial dyslipidemia needing an earlier treatment to prevent the development of macrovascular disease.