Screening and Evaluation of Homocysteine and Apolipoprotein A-1 As Atherogenic Markers in Sudanese with Long Standing Diabetes Mellitus Type 2

Abstract

A cross-sectional study conducted during the period from February 2008 to February 2011 to screen and evaluate the plasma levels of total homocysteine (tHcy) , apolipoprotein A-1 (ApoA-1) and lipid profile in Sudanese with long standing type2 diabetes mellitus.. Two hundred Sudanese with type 2 diabetes mellitus were selected as a test group from Jabir Abuelizz Diabetes Centre and Alhoda centre in Khartoum state, Sudan. The test group was compared with a control group which included 100 apparently healthy volunteers. Blood specimens were collected from both groups, and the serum levels of total homocysteine (tHcy) ,apolipoprotein A-1 and lipid profile (total cholesterol, triglycerides, high density lipoprotein cholesterol (HDLc) and low density lipoprotein cholesterol LDLc), in addition to fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) were determined. Age and gender of the test group were matched with the control group. The serum levels of (tHcy) were measured using A25 autoanalyzer and for the serum levels of (ApoA-1) were measured using an autoanalyzer A15 with commercial kits from Spinreact Company and spectrophotometeric methods were used for measuring the plasma levels of glucose ,.total cholesterol, .HDLc, .LDLc, .triglycerides, and HbA1C% . Statistical Package for Social Science (SPSS version 11.5) computer software was used for data analysis. The results of this study indicate statistically significant increase in the plasma levels of homocysteine ,total cholesterol , triglycerides , LDL-c, HbA1c and fasting blood glucose levels, whereas apolipoprotein A-1 and HDL-c levels shows a significant reduction in the test group when compared to the control group. The result of this study indicate also statistically significant elevation in homocysteine and triglycerides among diabetics group with foot disease when compared with those without foot disease ,whereas apolipoprotein A-1 and HDL- iii c among diabetic patients with ‫ا‬foot disease show a significant reduction when compared with those without foot disease. The mean of the plasma levels of homocysteine among diabetic patients with hypertension show a significantly elevation when compared with those without hypertension, whereas the means of the plasma levels of apolipoprotein A-1, total cholesterol, triglycerides, HDL-c, LDL-c, among diabetic patients with hypertension show insignificant difference when compared with those without hypertension. In the diabetics group with eye disease the mean of the plasma levels of apolipoprotein A-1, total cholesterol, LDL-c and HDL-c show a significant increase when compared with those without eye disease. In this study, the diabetic group treated with lipid-lowering agents have a significant high homocysteine levels but total cholesterol , triglycerides and LDL are significantly reduced ,whereas in the diabetic group treated with multivitamins only homocysteine show a significant reduction and there were no significant change in the lipemic profile. In reference to gender, this study shows that females have significantly higher levels of HDL and polipoprotein A-1 , insignificant difference in LDL-c cholesterol , triglycerides and total cholesterol levels when compared to males. The results of this study indicate statistically significant elevation in homocysteine, total cholesterol and triglycerides among diabetics group with ischemic heart disease when compared with those without ischemic heart disease ,whereas apolipoprotein A-1 and HDL-c among the diabetic group with ischemic heart disease show a significant reduction when compared with those without ischemic heart disease. The results of the current study indicate insignificant correlations between the HbA1C% and the serum levels of homocysteine, triglycerides and LDL-c, and show significant positive correlations between the HbA1C% and the plasma levels of iv total cholesterol, , whereas there is a significant moderate negative correlation between the HbA1C% and the serum levels of as apolipoprotein A-1 and HDLc. The present study, show significant moderate correlations between the body mass indexs (BMI) of the diabetic patients and the serum levels of homocysteine ,total cholesterol and LDLc, , and also shows a weak negative correlation between the BMI of diabetic patients and the serum levels of HDL-c, where as there are insignificant correlations between the (BMI) and the serum levels of apolipoprotein A-1, triglycerides and LDL-c. Diabetic patients with worse glycemic control (HbA1c% > 7%) in this study have significantly raised plasma levels of homocysteine , total cholesterol , triglycerides , LDL-c and fasting blood glucose but, apolipoprotein A-1 and HDL-c significantly decrease . The present study also shows a significant strong correlation between the HbA1C and FPG , apolipoprotein A-1 and HDL-c, In conclusion; the current study indicates that the serum levels of homocysteine , apolipoprotein A-1 and lipid profle are important markers for evaluation of atherosclerosis, because homocysteine is significantly correlated with the BMI and significantly increase in diabetic patients with worse glycemic control, whereas apolipoprotein A-1 is negatively correlated with HbA1C%. High plasma levels of homocysteine and low levels of apolipoprotein A-1 are risk factors for atherosclerotic disease, so they can be used as prognostic markers and predictors of myocardial infarction and in follow up of diabetic patients especially in those with complications such as hypertension, ischemic heart disease and lipid abnormalities.