الفهرس 
Diabetes and Coronary ArteryOnly 14 pages are availabe for public view
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Abstract
Type 2 diabetes mellitus is a disease with high
incidence and prevalence in Egypt. It is associated with
high incidence of cardiovascular disease and complications.
It has been suggested that the ApoE gene
polymorphism may be associated with predisposition to
diabetic complications (both micro and macrovascular
complications).
Individuals with different ApoE genotypes have
different susceptibilities to CAD. Studies have shown that
the E4 allelic variant is associated with the mechanisms of
development of atherosclerosis.
Several large cohort studies report that the ApoE4
allele is associated with an increased risk of CAD and other
studies found no association between the E4 allele and
CAD.
Information on the significance of ApoE
polymorphism in elderly subjects is limited and there are
few studies of the effects of ApoE on CVD in older people.
Carotid atherosclerosis was considered a surrogate
marker for coronary atherosclerosis, and thus, the
measurement of CIMT by ultrasound provides a
quantitative basis for the extent of atherosclerosis. Our study aimed to characterize the genotypes of
ApoE in diabetic elderly patients from Egypt in order to
describe the allelic frequency of the ApoE gene and its
relation to coronary risk factors and carotid intimal- medial
thickness.
The study enrolled ninety elderly subjects who were
divided into thirty elderly diabetic subjects with
cardiovascular complications (group A), thirty elderly
diabetic subjects without cardiovascular complications
(group B) and thirty elderly subjects without DM as the
control group (group C). The three groups were matched
for age and sex
Every study participant was subjected to the following:
1. Ethical considerations.
2. Comprehensive geriatric assessment.
3. Determination of fasting blood sugar level
and 2 hour postprandial blood sugar.
4. Determination of serum lipids (total
cholesterol, LDL, HDL and triglycerides).
5. Apo E genotyping was tested by Polymerase
chain reaction (PCR) and restriction fragment
length polymorphism (RFLP).
6. Measurement of carotid intima-media
thickness by carotid duplex. The current study revealed that in diabetic subjects
with cardiovascular complications (group A), the most
frequent allele was E3 (60%) followed by E4 (40%) E2
allele was not presented, while in diabetic subjects without
cardiovascular complications (group B) the most frequent
allele was E2 (53.3%) followed by E4 (36.7%) and only
(10.0%) were E3 and in control group the most frequent
allele was E2 (46.7%) followed by E4 (30.0%) and
(23.3%) for E3.
Our study of ApoE genetic polymorphism evidenced
that E2 allele carriers were significantly more frequent in
either control or diabetics without cardiovascular
complications while, there was no statistically significant
difference between the 3 groups as regard the frequency of
ApoE4 allele, Consequently there was no association
between ApoE4 and cardiovascular complications in
elderly diabetic subjects, on the other hand, ApoE2 allele
may have a protective role against cardiovascular
complications.
Our study showed that HDL was significantly lower
in diabetic patients with cardiovascular compications in
comparison to control group.
The current study revealed that E4 allele was
associated with dyslipidemia in diabetic patient without
cardiovascular complications and healthy control but not in
diabetic patient with cardiovascular complications. The results showed higher mean LDL among ApoE4
carrier subjects compared to E3 and E2 and the difference
is significant statistically.
This study showed that the mean Carotid intimal
thickness was the highest (1.2±0.4) mm in diabetic patient
with cardiovascular complications and (1.1±0.2) in diabetic
patient without cardiovascular complications and the least
(1.0±0.2) in control group and this difference is significant
statistically (P=0.040). Also our study demonstrated that
carotid plaques, were significantly higher in group A when
compared to controls (P=0.012).
Concerning the relation between carotid artery
plaque and mean CIMT and different ApoE genotypes, our
findings implied that carotid plaques were significantly
more frequent among those have E4 alleles in diabetic
patients with cardiovascular complications. On the other
hand no significant association was observed between
ApoE alleles and mean CIMT in the whole study
population.
The effects of the ApoE genotypes on CVD in the
elderly reveals a complex system of relationships. ApoE
genotypes clearly influence lipids and may be linked to
atherosclerosis. However, the association of these
biomarkers with CVD outcomes is altered in the elderly, in
part by age- and time-dependent changes in exposure.