BEYOND LDL-CHOLESTEROL IN TYPE 2 DIABETES MELLITUS - NON HDLCHOLESTEROL AND RATIO OF TOTAL CHOLESTEROL AND HDLCHOLESTEROL FROM A SIMPLE LIPID PROFILE

BACKGROUND Diabetic dyslipidemia is characterised by elevated triglycerides concentration,low levels of HDLcholesterol(HDL-c), predominant small dense LDL particles amidst relatively normal LDL-cholesterol (LDL-c) levels.Thus looking at LDL-c alone may not be sufficient to assess the dyslipidemic status in diabetic patients with elevated triglyceride concentration as it does not includes other atherogenic apo B containing lipoproteins (VLDL, IDL and VLDL remnant lipoproteins).As apo B protein measurement cannot be routinely done,Non HDL-c calculated as total cholesterol minus HDL-c provides a better measure of all atherogenic apo B containing lipoproteins.The predictive value of the ratio of Total cholesterol (TC) and HDL-c is greater than the isolated lipid profile parameters.OBJECTIVE To compare the Non HDL-c levels and the ratio of TC and HDL-c with LDL-c levels in diabetics at various triglyceride concentration and to evaluate the utility of Non HDLc and the ratio of TC and HDL-c in assessing the dyslipidemia in diabetes.METHODS The study comprised of 60 type 2 diabetic patients and 30 controls. Anthropometric measurements and biochemical parameters (fasting plasma glucose and lipid profile) were measured.RESULTS Serum Triglycerides (TGL),TC,LDL-c,HDL-c,Non HDL-c and the ratio of TC and HDL-c were significantly different between diabetics and non diabetics.Diabetics were stratified into tertiles according to TGL levels.Diabetics in the third TGL tertile has higher ratio of TC and HDL-c and Non HDL-c for any given value of LDL- c value compared to diabetics in the other two tertiles.There was also a significant correlation between Non HDL-c and the ratio of TC and HDL-c with duration of diabetes,fasting glucose,Serum TGL,TC,HDL-c and LDL-c.CONCLUSION In diabetics,Non HDL-c and the ratio of TC and HDL-c from a simple lipid profile can project the dyslipidemic status in a better way than LDL-c estimated from Friedewald formula.Hence LDL-c levels alone cannot be a major goal for the diagnosis and the treatment of diabetic dyslipidemia.