RESUMO
Background and aim: Presence of metabolic syndrome (MS) in patients with type 2 diabetes mellitus (T2DM) involves an increased risk of cardiovascular disease and death. Markers such as ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios have been used to predict this risk with conflicting results. The study objective was to establish the relationship between the apoB/apoA1 and non-HDL-cholesterol/HDL-cholesterol ratios and MS in T2DM patients from a Madrid (Spain) district. Patients and methods: One hundred patients with T2DM who attended University Hospital Infanta Leonor (Vallecas, Madrid, Spain) between January 2014 and June 2017 were enrolled. A blood sample was taken every 6 months from all patients to measure the different lipid parameters and to calculate ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. A Mann-Whitney's U test to compare means and a Spearman's correlation test for correlations between variables were used, and a multivariate regression analysis was performed to determine the association between MS and the ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. Values of p < 0.05 were considered significant. Results: Associations were found between MS and ApoA1 (R2 = 0.164, p = 0.028), ApoB/ApoA1 (R2 = 0.187, p = 0.001), and non-HDL-cholesterol/HDL-cholesterol (R2= 0.269, p = 0.0001) ratios and, in women with MS, between ApoB/ApoA1 ratio and ischemic cardiomyopathy (IC) (R2 = 0.160, p = 0.032). Associations remained after adjusting for comorbidities and risk factors. Conclusions: In the T2DM patients studied, MS was independently associated to ApoA1 and the ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. Both ratios were better predictors of MS in T2DM subjects that its components alone. The ApoB/ApoA1 ratio could be used as a cardiovascular risk marker in women with MS
Antecedentes: La presencia del síndrome metabólico (MetS) en pacientes con diabetes mellitus tipo 2 (T2DM) conlleva mayor riesgo de enfermedad cardiovascular y muerte. Se han utilizado marcadores para predecir este riesgo, como los índices ApoB/ApoA1 y no-HDL-C/HDL-C, pero con resultados controvertidos. El objetivo ha sido determinar las relaciones entre los índices ApoB/ApoA1 y no-HDL-C/HDL-C y el MetS en pacientes con T2DM de un distrito de Madrid, España. Pacientes y métodos: Se reclutaron 100 pacientes con T2DM del Hospital Universitario Infanta Leonor (distrito de Vallecas, Madrid). A todos, entre enero de 2014 y junio de 2017, se les determinaron cada 6 meses los diferentes parámetros lipídicos, calculándose los índices ApoB/ApoA1 y no-HDL-C/HDL-C. De cada parámetro se realizó una media de 4-5 determinaciones. Se utilizó la U de Mann-Whitney para las comparaciones entre medias, la correlación de Spearman para las relaciones entre variables y un análisis de regresión multivariable para determinar la asociación entre el MetS y los índices ApoB/ApoA1 y no-HDL-C/HDL-C. Una p < 0,05 fue significativa. Resultados: Se han observado asociaciones entre MetS y ApoA1 (R2 = 0,164; p = 0,028), ApoB/ApoA1 (R2 = 0,187; p = 0,001) y no-HDL-C/HDL-C (R2 = 0,269; p = 0,0001); y en mujeres con MetS, entre ApoB/ApoA1 y cardiomiopatía isquémica (IC) (R2 = 0,160; p = 0,032), que permanecen después de ajustar las comorbilidades y los factores de riesgo. Conclusiones: En los pacientes con T2DM estudiados, el MetS se asocia de forma independiente con ApoA1, ApoB/ApoA1 y con no-HDL-C/HDL-C. Ambos índices son mejores predictores de MetS que sus componentes por separado. El índice ApoB/ApoA1 podría usarse como marcador de riesgo cardiovascular en mujeres con MetS
