Aim of work: The aim of this work is to euaLuate the preuatence of apolipoprotein-
E (Apo E) gene polymorphisms in type-2 diabetes mellitus
(n* with coronary heart disease (CHI)) and their influence on the severity
of the disease, lipid profile and other risk factors (e_g. smoking, hypertension,
body mass index and glycosylated hemoglobin Ale). Patients
and metlietv One hundred and twenty cases with type-2 DM were selected
from those admitted to Internal Medicine and Cardiology Departments
of Henna University Hospitals. Their ages ranged from 43 to 65
years (with a mean rigit, of 52± 8.21. They were demented into 3 groups:
group I included 30 diabetic cases with ischemic ECG changes. group .11
included 30 diabetic cases with myocardial infarction (Study groups) and
group III included 60 diabetic crises without CUD (Control group) Diagnor
sts of type 2 diabetes mellitus was made according to the criteria of
American Diabetes Association. Diagnosis of CUD was determined front
the history of rnangina pectoris, ischemic ECG changes. documented
myocardial infarction, or major Q waves on a resting electrocardiogram
Results: The Apo E4 patients showed the highest prevalence of
CUD (71.496), followed ay Apo E3 patients (47.7%) and lastly Apo E2 patients
(20%). On comparison, there was a statistical significant difference
between Apo E2 and Apo E4 genotype patients (P<0.05); while the dnference
between Apo E2 and Apo E3 and between Apo £3 and Apo E4 genotype
didn't yield statistical significant difference (P>0.05 respectively). On
the contrary Apo E2 patients showed the highest prevalence of non-CUD
(80%), followed by Apo E3 (52.3%) and Lastly Apo E4 (28.69&). Regarding
the distribution of Apo E genotypes among groups with CUD and those
without CHD, them were no statistical significant differences between
each Apo E genotypes (Apo E2. E3 & E4) in group I compared to group II
(P'>0.05 respectively), while there was a statistical significant difference
between Apo E2 and Apo E3 patients in group III compared to group I and
group II (P< 0.05 respectively). Also, no statistical significant differences
were found between different Apo E genotypes (Apo E2, E3 & E4) and
other CHD risk factors (e.g. smoking, hypertension, HIV)! and HbA Ic;
P>0.05 respectively). As regarding the relationship between lipid profile
and Apo E genotype; the results were as follows: For serum cholesterol.
there was a highly significant difference between Apo £2 and each of Apo
E4 and Apo E3 patients (P<0.05 respectively), while the dyrerence between
Apo E4 and Apo E3 patients (E4>E3) was not too big to give a statistical
significance (P>0.05). For serum low density Lipoprotein cholesterol
( LDL-c), there was a highly significant difference between Apo E2 and
Apo E4 patients (Pc0.00.1), and significant dffferences between Apo E3
and each of Apo E2 and Apo E4 patients (P<0.05 & P<0.01 respectively).
For serum triglycertdes(Ms) and serum high density lipoprotein cholesterol
IHDL-c), the results of our study showed that Apo .E2 and Apo E4 genotype
patients had higher TGs and lower HDL-c levels in comparison to
Apo E3 patients but the differences were statistically insignificant
(P>0..05 respectively)... Conclusion: Apoiipoprotein E gene polymorphism
is an important risk factor for the development of CHD in type 2 diabetic
patients, 64 allele plays as a risk factor and 62 allele plays as a
protective factor. The role of 84 in the development of CUD is partly mediated
by its effect on serum total cholesterol and LDL cholesterol levels.
Recommendation: Further studies on large number of patients with long
term follow-up periods are needed to determine the relationship between
84 allele and severity of disease in CUD diabetic poilionts Also further
studies are recommended to know i164 can act as a predicettar of mortality
in these patients and to explain the exact role of 64 allele in the development
of aila in type 2 diabetic patients; and the contribution of lipid
profile and other CUD riskfactors. |
