American Journal of Epidemiology Vol. 130, No. 4: 632-645
Copyright © 1989 by The Johns Hopkins University School of Hygiene and Public Health
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SERUM LlPffiS, LIPOPROTEINS, AND APOLIPOPROTEINS AND THE EXCESSIVE OCCURRENCE OFCORONARY HEART DISEASE IN NON-INSULIN-DEPENDENT DIABETIC PATIENTS
1Rehabilitation Research Centre of the Social Insurance Institution Peltolantie 3, SF-20720 Turku, Finland
2Department of Medicine, Kuopio University Central Hospital 70210 Kuopio, Finland.
Serum lipids, lipoproteins, and major apollpoproteins and their association with previous myocardlal infarction were studied in patients with non-lnsulin-depen-dent diabetes mellitus (NIDDM) and nondiabetic subjects in East and West Finland in 1982-1984. NIDDM patients had higher age-adjusted serum triglyceride and apolipoprotein B levels and a higher apolipoprotein B/apolipoprotein A-l ratio, lower serum high density lipoprotein (HDL) cholesterol and apolipoprotein A-l levels, and a lower HDL cholesterol/apolipoprotein A-l ratio than nondiabetic subjects. With a few exceptions, these differences persisted after adjustment for body mass index, alcohol intake, physical activity, smoking, and hypertension, which suggests that the atherogenic serum lipoprotein pattern in NIDDM Is an inherent feature of the disease. In general, the association of serum lipids, lipoproteins, and apolipoproteins with myocardial infarction was similar in nondiabetic subjects and NIDDM patients, although it was somewhat stronger In the diabetic subjects. A low serum HDL cholesterol/apolipoprotein A-l ratio, which was closely linked to high serum triglyceride level, seemed to be more consistently related to myocardial infarction in NIDDM patients than in nondiabetic subjects Serum lipids, lipoproteins, and apolipoproteins, either separately or in various combinations, could only to a small extent explain the higher prevalence of myocardial infarction in diabetic subjects compared with nondiabetic subjects when tested in multivariate analysis with other cardiovascular risk factors as background variables. The association between serum lipoproteins and myocardial infarction was largely similar in East and West Finland, two areas that differ markedly with respect to the occurrence of coronary heart disease.
apolipoproteins; coronary disease; diabetes mellitus; non-insulln-dependent; lipids; lipoproteins; myocardial Infarction
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