Postprandial Hypertriglyceridemia And Its Influence On The Vascular Endothelial Function In Elderly Diabetic Patients

Objective:The risk of developing atherosclerosis in diabetic patients is two to four times higher than non-diabetic subjects. These atherosclerotic diseases are extensive and develop rapidly. Cardiac and cerebral vascular complications are the major fatal reason of diabetes. The major risk factors of developing cardiac-cerebral vascular diseases include dyslipidemia, hypertension, hyperglycemia and smoking, et, al in which dyslipidemia is the most important one. Postprandial hyperlipidemia, mostly hypertriglyceridemia is the independent risk factor of coronary artery disease. Carotic intima-media thickness(IMTc) and the brachial artery flow-mediated vasodilation(FMD) are two non-invasive markers of detecting atherosclerosis. The aim of this study is to investigate the postprandial hypertriglyceridemia in elderly diabetic patients and its effect on the endothelial function, so as to explore the mechanism of diabetes inducing AS, and to present objective evidence for early preventing and treating diabetic complications. Methods:60 patients of fasting normotriglyceridemia were selected as observed group and were divided into two groups, diabetic group and non-diabetic group. The patients' age wasn't below 60 years old. The fatty meal test was done after having been fasting for 12h. Serum lipids were measured at 0 , 2 , 4 and 6h. IMTc and FMD in the brachial artery were assessed by high-resolution ultrasound technique at 0 , 4h after the meal.Results:1 The serum TG level increased in the two groups after the meal, but TG area under curve TG-AUC in the diabetic group was higher than the non-diabetic group (PO.05).2 IMTc was significantly higher and FMD was obviously impaired in diabetic group compared with the non-diabetic group(P<0.05).3 The IMTc in the two groups didn't change significantly after the meal, but the postprandial FMD significantly decreased in the two groups(P<0.05); and the percent decrement of FMD( A FMD) in the diabetic patients was obviously higher than that in the non-diabetic patients(P<0.05).4 The postprandial TG-AUC was positively correlated with the increasement of TG level at 4h (ATG4) after the meal (r=0.79,P<0.05) .5 By multiple logistic regression analyses, it showed that the increasement of TG level at 2h(ATG2) after the meal associated independently and significantly with A FMD.Conclusion:1 The elderly diabetic patients with normotriglyceridemic level existed dominant postprandial hypertriglyceridemia after the fatty meal;2 FMD was impaired at preprandial time and was much severer in postprandial period.3 Postprandial 2h TG level was an independent risk factor of A FMD in elderly diabetic patients.These findings indicated that postprandial hypertriglyceridemia enhanced endothelial dysfunction and accelerated the occurance and development of AS, detecting postprandial lipidemia and interfering it play important roles on preventing diabetic AS occurance and development.