Hypertriglyceridemic waist predicts CAD in Type 2 diabetes
MedWire News: The combination of a large waist circumference and elevated plasma triglyceride (TG) levels in patients with Type 2 diabetes can predict the presence of coronary artery disease (CAD), study results show.
This combination, termed "hypertriglyceridemic waist," could provide "a simple, low-cost biomarker for CAD, enabling the identification of patients who are at increased cardiovascular risk," say Jeroen Bax (Leiden University Medical Center, The Netherlands) and colleagues in the American Journal of Cardiology.
Bax and colleagues aimed to see if the Quebec Cardiovascular Study finding of an association between the hypertriglyceridemic waist phenotype and the "atherogenic metabolic triad," defined as increased insulin, small dense low-density lipoprotein particles, and apolipoprotein B, could be extended to patients with diabetes.
They assessed waist circumference and TG levels in 202 patients with Type 2 diabetes who were clinically referred for tomographic coronary angiography (CTA).
The patients were divided into four groups using threshold values for waist circumference (≤88 or >88 cm for women and ≤102 or >102 cm for men) and TG levels (<1.7 or ≥1.7 mmol/l for both men and women) as previously described by the National Cholesterol Education Program Adult Treatment Panel III.
Patients with elevated waist circumference and TG levels (n=61, 31%) were considered to have the hypertriglyceridemic waist phenotype, while patients with low waist circumference and TG levels (n=49, 24%) served as the reference group.
Bax and colleagues found that in patients with hypertriglyceridemic waist, plasma cholesterol levels were significantly elevated while high-density lipoprotein cholesterol was significantly reduced compared with the reference group.
The presence of any CAD and obstructive CAD was significantly increased in patients with hypertriglyceridemic waist relative to the reference group, at odds ratios of 3.3 and 2.9, respectively.
In addition, a significantly larger number of noncalcified and mixed plaques was observed in the hypertriglyceridemic waist group relative to the reference group.
Discussing the findings, Bax et al note that screening for CAD in patients with Type 2 diabetes in the presence of two or more additional traditional cardiovascular risk factors has been endorsed by the American Diabetes Association, although evidence for the effectiveness of routine screening of patients is lacking.
"In this setting, the hypertriglyceridemic waist phenotype may potentially serve as a practical biomarker for CAD to increase risk stratification in this patient population," Bax and colleagues comment.
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By Andrew Czyzewski