Lipid Levels and Associated Cardiovascular Risk Factors in Moroccan Type 2 Diabetes: A Case Control Study (EPIDIAM Study)
DOI:
https://doi.org/10.12970/2310-9971.2014.02.01.1Keywords:
Type 2 Diabetes Mellitus, Dyslipidaemia, Cardiovascular disease, Risk factors, Morocco.Abstract
Background: The management of diabetic dyslipidaemia, a well-recognized and modifiable risk factor, is a key element in the multifactorial approach to prevent cardiovascular diseases (CVD) in individuals with type 2 diabetes (T2DM). Objective: The aim of this study is to describe lipids profile and to compare CVD risk factors in Moroccan individuals with and without T2DM. Subjects and Methods: The study population consisted of 1307 unrelated T2D and 984 non-diabetics subjects. This was a case control study carried out in urban and rural primary health care centers. The survey was conducted from January 2006 to July 2008. Results: This case control study performed in a group of type 2 diabetic patients (1307) and non-diabetic (984) adults’ shows that T2D is strongly and independently associated with CVD risk factors, which are, hypertension (OR 4.06, 95% CI: 3.35-4.93, p <0.001), elevated TGs (OR 1.77, CI: 1.45-2.18, p <0.001), central obesity (OR 1.67, CI: 1.30-2.16, p <0.001), been female (OR 0.79, CI: 0.64-0.97, p =0.022), and been older-age (p =0.001). Strong prevalence of CVD risk factors has also shown among non-diabetics. Conclusion: The present study has found a high prevalence of CVD risk factors among T2D patients and controls despite the significant difference between them.References
[1] Ferguson LD, Sattar N. Reducing cardiovascular disease risk in type 2 diabetes: is the focus on glycaemia warranted? Diabetes Obes Metab 2013; 15: 387-91. http://dx.doi.org/10.1111/dom.12018
[2] van de Weijer T, Schrauwen-Hinderling VB, Schrauwen P. Lipotoxicity in type 2 diabetic cardiomyopathy. Cardiovasc Res 2011; 92: 10-8. http://dx.doi.org/10.1093/cvr/cvr212
[3] Eckel RH, Kahn R, Robertson RM, Rizza RA. Preventing cardiovascular disease and diabetes. A call to action from the American Diabetes Association and the American Heart Association. Diabetes Care 2006; 29: 1697-9. http://dx.doi.org/10.2337/dc06-9911
[4] Kalra S, Unnikrishnan AG. Diabetes and dyslipidaemia. J Pak Med Assoc 2013; 63: 788-91.
[5] The Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375: 2215-22. http://dx.doi.org/10.1016/S0140-6736(10)60484-9
[6] The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26: 3160-7. http://dx.doi.org/10.2337/diacare.26.11.3160
[7] Friedwald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499-502.
[8] American Diabetes Association. Management of dyslipidemia in adults with diabetes. Diabetes Care 2003; 26(Suppl 1): S83-S86. http://dx.doi.org/10.2337/diacare.26.2007.S83
[9] WHO Expert Consultation. Waist Circumference and WaistHip Ratio: Report of a WHO Expert Consultation. GENEVA, 8–11 DECEMBER 2008. 2011. (http://www.who.int/ nutrition/publications/obesity/WHO_report_waistcircumferenc e_and_waisthip_ratio/en/)
[10] Sharma MD, Farmer JA, Garber A. Type 2 diabetes and cardiovascular risk factors. Curr Med Res Opin 2011; 27(Suppl 3): 1-5. http://dx.doi.org/10.1185/03007995.2011.620083
[11] Janghorbani M, Amini M. Hypertension in type 2 diabetes mellitus in Isfahan, Iran. Incidence and risk factors. Diabetes Res Clin Pract 2005; 70: 71-80. http://dx.doi.org/10.1016/j.diabres.2005.02.017
[12] Mubarak FM, Froelicher ES, Jaddou HY, Ajlouni KM. Hypertension among 1000 patients with type 2 diabetes attending a national diabetes center in Jordan. Ann Saudi Med 2008; 28: 346-51. http://dx.doi.org/10.4103/0256-4947.51684
[13] Bener A, Zirie M, Janahi IM, Al-Hamaq AO, Musallam M, Wareham NJ. Prevalence of diagnosed and undiagnosed diabetes mellitus and its risk factors in a population-based study of Qatar. Diabetes Res Clin Pract 2009; 84: 99-106. http://dx.doi.org/10.1016/j.diabres.2009.02.003
[14] Al-Shehri AM. Blood pressure control among type 2 diabetics. Saudi Med J 2008; 29: 718-22.
[15] Al-Moosa S, Allin S, Jemiai N, Al-Lawati J, Mossialos E. Diabetes and urbanization in the Omani population: an analysis of national survey data. Popul Health Metr 2006; 24: 4-5.
[16] Al-Mahroos F, Al-Roomi K, McKeigue PM. Relation of high blood pressure to glucose intolerance, plasma lipids and educational status in an Arabian Gulf population. Int J Epidemiol 2000; 29: 71-6. http://dx.doi.org/10.1093/ije/29.1.71
[17] Comaschi M, Coscelli C, Cucinotta D, et al. Cardiovascular risk factors and metabolic control in type 2 diabetic subjects attending outpatient clinics in Italy: the SFIDA (survey of risk factors in Italian diabetic subjects by AMD) study. Nutr Metab Cardiovasc Dis 2005; 15: 204-11. http://dx.doi.org/10.1016/j.numecd.2004.07.003
[18] Del Cañizo-Gómez FJ, Moreira-Andrés MN. Cardiovascular risk factors in patients with type 2 diabetes. Do we follow the guidelines? Diabetes Res Clin Pract 2004; 65: 125-33. http://dx.doi.org/10.1016/j.diabres.2003.12.002
[19] Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348: 383-93. http://dx.doi.org/10.1056/NEJMoa021778
[20] Gray A, Clarke P, Farmer A, Holman R. United Kingdom Prospective Diabetes Study (UKPDS) Group. Implementing intensive control of blood glucose concentration and blood pressure in type 2 diabetes in England: cost analysis (UKPDS 63). BMJ 2002; 325: 860-5. http://dx.doi.org/10.1136/bmj.325.7369.860
[21] Fang J, Wylie-Rosett J, Cohen HW, Kaplan RC, Alderman MH. Exercise, body mass index, caloric intake, and cardiovascular mortality. Am J Prev Med 2003; 25: 283-9. http://dx.doi.org/10.1016/S0749-3797(03)00207-1
[22] Jeon CY, Lokken RP, Hu FB, van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Diabetes Care 2007; 30: 744-52. http://dx.doi.org/10.2337/dc06-1842
[23] Salman RA, Al-Rubeaan KA. Incidence and risk factors of hypertension among Saudi type 2 diabetes adult patients: an 11-year prospective randomized study. J Diabetes Complications 2009; 23: 95-101. http://dx.doi.org/10.1016/j.jdiacomp.2007.10.004
[24] Elnasri HA, Ahmed AM. Patterns of lipid changes among type 2 diabetes patients in Sudan. East Mediterr Health J 2008; 14: 314-24.
[25] Broussard DL, Magnus JH. Influence of cardiovascular disease risk factors on the relationship between low bone mineral density and type 2 diabetes mellitus in a multiethnic US population of women and men: a cross-sectional study. Gend Med 2008; 5: 229-38. http://dx.doi.org/10.1016/j.genm.2008.07.006
[26] Siraj SE, Seyoum TB, Saenz C, Abdulkadir J. Lipid and lipoprotein profiles in Ethiopian patients with diabetes mellitus. Metabolism 2006; 55: 706-10. http://dx.doi.org/10.1016/j.metabol.2005.08.002
[27] Smaoui M, Hammami S, Chaaba R, et al. Lipids and lipoprotein (a) concentrations in Tunisian type 2 diabetic patients relationship to glycemic control and coronary heart disease. J Diabetes Complications 2004; 18: 258-63. http://dx.doi.org/10.1016/S1056-8727(03)00075-8
[28] Harzallah F, Alberti H, Kanoun F, Elhouch F, Slimane H. Quality of care of patients with type 2 diabetes in a Tunisian university hospital. Diabetes Metab 2004; 30: 523-6. http://dx.doi.org/10.1016/S1262-3636(07)70150-7
[29] Agrawal RP, Sharma P, Pal M, Kochar A, Kochar DK. Magnitude of dyslipidemia and its association with micro and macro vascular complications in type 2 diabetes. A hospital based study from Bikaner (Northwest India). Diabetes Res Clin Pract 2006; 73: 211-4. http://dx.doi.org/10.1016/j.diabres.2006.01.006
[30] Pouliot MC, Desprès JP, Lemieux S, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994; 73: 460-8. http://dx.doi.org/10.1016/0002-9149(94)90676-9
[31] Smith SC Jr. Multiple risk factors for cardiovascular disease and diabetes mellitus. Am J Med 2007; 120(Suppl 1): S3- S11. http://dx.doi.org/10.1016/j.amjmed.2007.01.002
[32] Czernichow S, Kengne AP, Huxley RR, et al. Comparison of waist-to-hip ratio and other obesity indices as predictors of cardiovascular disease risk in people with type-2 diabetes: a prospective cohort study from ADVANCE. Eur J Cardiovasc Prev Rehabil 2011; 18: 312-9. http://dx.doi.org/10.1097/HJR.0b013e32833c1aa3
[33] Shah A, Bhandary S, Malik SL, Risal P, Koju R. Waist circumference and waist-hip ratio as predictors of type 2 diabetes mellitus in the Nepalese population of Kavre District. Nepal Med Coll J 2009; 11: 261-7.
[34] Jousilahti P, Vartiainen E, Tuomilehto J, Puska P. Sex, age, cardiovascular risk factors and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland. Circulation 1999; 99: 1165-72. http://dx.doi.org/10.1161/01.CIR.99.9.1165
[35] Juutilainen A, Kortelainen S, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Gender difference in the impact of type 2 diabetes on coronary heart disease risk. Diabetes Care 2004; 27: 2898-904. http://dx.doi.org/10.2337/diacare.27.12.2898
[36] Garber AJ. Vascular disease and lipids in diabetes. Med Clin North Am 1998; 82: 931-48. http://dx.doi.org/10.1016/S0025-7125(05)70030-4
[37] El Rhazi K, Nejjari C, Zidouh A, Bakkali R, Berraho M, Barberger Gateau P. Prevalence of obesity and associated sociodemographic and lifestyle factors in Morocco. Public Health Nutr 2011; 14: 160-7. http://dx.doi.org/10.1017/S1368980010001825
[38] Najdi A, El Achhab Y, Nejjari C, Norat T, Zidouh A, El Rhazi K. Correlates of physical activity in Morocco. Prev Med 2011; 2: 355-7. http://dx.doi.org/10.1016/j.ypmed.2011.03.009