Assessment of Apolipoprotein C- III as A predictor of Cardiovascular Diseases among Type 2 Diabetic Men in Gaza Strip

Abstract

Background: Diabetes mellitus is one of the most important risk factors for cardiovascular diseases. Apolipoprotein C-III (apo C-III) is a multifunctional protein that not only regulates the metabolism of triacylglycerols but also an important regulator of endothelial function. In the presence of hyperlipidema, apo C-III exerts proinflammatory effects on both monocytes and endothelial cells that are important for transendothelial migration of monocytes into the vessels’ intima and development of atherosclerosis. Objectives: To investigate the prognostic value of plasma apo C-III concentrations for cardiovascular complication among Type 2 Diabetes mellitus (T2DM) patients in Gaza strip. Subjects and methods: This study is a case-control study; a total of 89 male of T2DM were evaluated and classified into two groups according to heart disease [52 of T2DM patients without heart disease and 37 with heart disease] and equal number of normal subjects (n=89) were run in parallel with each group as a control. Apo C-III and apoA1 were measured using immunoturbidimetric methods. Glucose, creatine kinase (CPK), creatine kinase MB (CK-MB), aspartate aminotransferase (AST), Lactate aminotransferase (LDH), cholesterol, triacylglycerols (T.G) and, HDL-C were measured using colorimetric and kinetic method and low density lipoprotein (LDL-C) was calculated using the empirical relationship of Friedewald. Results: The concentration of apo C-III, glucose, LDL, cholesterol, triacylglycerols, apoA1, LDH, AST, CPK and, CK-MB were significantly increased among T2DM patients (P<0.05). There was positive correlation between apo C-III and plasma triacylglycerols in T2DM patients compared with control (r=0.755, p=<0.001 and r=0.426, p=0.001 respectively). Also, there were positive correlation between apo C-III and glucose, cholesterols, AST and apoA1 among T2DM patients (r=0.238,p=0.012, r=0.340,p=0.001, r=0.237,p=0.013, r=0.242, p=0.011 respectively). There was statistically significant difference between apo C-III (p<0.05) in the two cases groups of T2DM (with/without heart disease) and between the obese and non-obese T2DM patients. There was significant difference between apo C-III and insulin treatment (p<0.05), while no significant difference was found between lipid-lowering drug and apo C-III. Conclusion: High level of Apo C-III and low level of apoA1 concentration in plasma, independently of fasting triacylglycerols and other traditional risk factors, predicts cardiovascular mortality among T2DM patients.