Gender differences in the effect of type 2 diabetes on serum lipids, pre-heparin plasma lipoprotein lipase mass and other metabolic parameters in Japanese population.

DESIGN: Cross-sectional study of fasting serum lipid and lipoprotein levels, pre-heparin lipoprotein lipase (LPL) mass, several other metabolic parameters, and intra-abdominal fat areas in 26 Japanese poorly controlled type 2 diabetic men and 23 women when matched for age, body mass index (BMI), and HbA1c between genders. SUBJECTS: Study subjects were Japanese type 2 diabetic patients who were admitted to our hospital between Jun 2001 and Aug 2002 because of their poorly controlled diabetes. A total of 49 subjects [40-79 years of age, average age 61.5 +/- 8.7; mean BMI 23.2 +/- 3.7 kg/m2] with fasting plasma glucose (PG) and HbA1c levels being 251 +/- 76.5 mg/dl and 10.8 +/- 2.2%, respectively, were involved in this study. METHODS: Pre-heparin LPL mass was determined by enzyme linked immunosorbent assay. Remnant like particle cholesterol (RLP-C) level was measured using an immunoaffinity mixed gel containing anti-apolipoprotein (apo) A-I and anti-apo B monoclonal antibodies. Serum leptin level was determined by radioimmunoassay. Intra-abdominal fat area was determined by computerized tomography analysis at the umbilical level. RESULTS: The men group showed a higher serum triglycerides (TG) and RLP-C levels, and lower high density lipoprotein-cholesterol levels and pre-heparin plasma LPL mass than did women. Serum leptin level was higher in women than in men counterparts. The intra-abdominal subcutaneous fat areas were significantly larger in women than in men counterparts, whereas the visceral fat areas did not differ. CONCLUSION: In Japanese population, poorly controlled type 2 diabetic men had more unfavorable lipid profile than did women counterparts, which may be associated with decreased lipolysis of plasma TG-rich lipoproteins by LPL.

Marked reduction in serum high-density lipoprotein cholesterol concentrations in a woman with acute inflammation due to diabetic gangrene.

BACKGROUND: C-reactive protein (CRP) is a well-established, sensitive marker of systemic inflammation and the risk of cardiovascular disease. High-density lipoprotein (HDL) is an anti-atherogenic lipoprotein known to be regulated by genetic and acquired factors. METHODS: The patient was a 77-year-old Japanese woman, who was diagnosed with type 2 diabetes mellitus (DM), with a body height of 152 cm and a weight of 65 kg (body mass index 28.1 kg/m2). She suffered from diabetic foot gangrene in her right foot with high-grade fever when she visited our hospital. Her plasma glucose (PG) concentration and serum CRP were markedly elevated being 21.6 mmol/l and 370 mg/l, respectively, while her serum HDL-C concentrations were markedly low being 0.13 mmol/l. She was immediately admitted to our hospital and received intensive insulin treatment, along with intravenous-administration of antibiotics. Her general conditions were gradually improved and the high-grade fever disappeared, with concentrations of plasma PG and serum CRP being reduced, and concurrent reciprocal increase in her serum HDL-C concentrations. RESULTS: To determine the potential causative factors responsible for the drastic change in serum HDL-C concentrations, we investigated the relationship of serum HDL-C to serum CRP, serum total protein (TP) and PG. Serum CRP and PG showed inverse relationships with serum HDL-C, while serum TP concentrations showed a positive association with HDL-C. After multivariate analyses with CRP, TP and PG as independent variables and serum HDL-C as dependent variable, CRP maintained its independent association with serum HDL-C. CRP also showed inverse correlations with lipoprotein lipase (LPL) mass and cholesteryl ester transfer protein mass. CONCLUSIONS: In acute inflammation and poorly controlled diabetes, CRP is suggested to be inversely associated with serum HDL-C, independent of PG and TP.

Single LDL apheresis improves serum remnant-like particle-cholesterol, C-reactive protein, and malondialdehyde-modified-low-density lipoprotein concentrations in Japanese hypercholesterolemic subjects.

BACKGROUND: Single low-density lipoprotein (LDL)-apheresis may affect serum remnant-like particle-cholesterol (RLP-C), C-reactive protein (CRP) and malondialdehyde-modified (MDA)-LDL concentrations. SUBJECTS AND METHODS: Six subjects with hypercholesterolemia (five men, one woman) were involved in this study. Mean age and body mass index of the study subjects were 58+/-3.1 years and 23.6+/-2.07 kg/m(2), respectively. Five of the subjects were diagnosed as heterozygous familial hypercholesterolemia (FH) because of having both marked hypercholesterolemia and Achilles tendon xanthomas. LDL apheresis was introduced and continued using a dextran sulfate cellulose adsorption column technique every 2 weeks. Serum RLP-C was measured using an immunoaffinity mixed gel containing anti-apolipoprotein A-I and anti-apolipoprotein B monoclonal antibody. Serum CRP was measured by latex-enhanced assay. Serum MDA-LDL was measured using monoclonal antibody against MDA-LDL (ML25). RESULTS: Combined treatment in the steady state pre-treatment yielded a total, LDL- and HDL-cholesterol, and TG concentrations of 5.39+/-0.81, 3.82+/-1.03, 1.24+/-0.29 and 0.92+/-0.43 mmol/l, respectively, and a post-treatment total, LDL- and HDL-cholesterol and TG concentrations of 2.79+/-0.37 (-48%, p<0.001), 1.63+/-0.29 (-57%, p<0.001), 1.18+/-0.26 (-5%, NS) and 0.23+/-0.11 mmol/l (-75%, p<0.001), respectively. Serum RLP-C and CRP concentrations showed a substantial reduction [-73%, p<0.05 for RLP-C; -56%, p<0.05 for CRP] during this procedure. In addition, LDL apheresis was found to also cause a marked reduction in serum MDA-LDL concentration (-61%, p<0.05). CONCLUSION: LDL-apheresis is an effective treatment for removing atherogenic factors RLP-C, CRP and MDA-LDL from sera.