Apolipoproteins in diabetes dyslipidaemia in South Asians with young adult-onset diabetes: distribution, associations and patterns

Original Articles

Gaya W Katulanda^1,2,
Prasad Katulanda^3,4,
A I Adler⁵,
S R Peiris³,
I Draisey¹,
S Wijeratne⁶,
R Sheriff³,
D R Matthews⁴ and
Brian Shine¹

¹ Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK;
² Department of Pathology, National Hospital of Sri Lanka;
³ Diabetes Research Unit, Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka;
⁴ Oxford Centre for Diabetes Endocrinology and Metabolism, University of Oxford, Oxford, UK;
⁵ Institute of Metabolic Sciences, Addenbrooke’s Hospital, Cambridge, UK;
⁶ Endocrine and Reproductive Laboratory, University of Colombo, Colombo, Sri Lanka

Corresponding author: Dr Brian Shine. Email: brian.shine{at}orh.nhs.uk

Background: Apolipoproteins B (apoB) and AI (apoAI) are strong predictorsof cardiovascular disease (CVD). We describe apolipoproteindistributions and their associations with lipids and diabetessubtype in diabetic young adult South Asians.

Methods: In 995 subjects with diabetes, we measured fasting total cholesterol(TC), high-density lipoprotein cholesterol (HDLC), triglycerides(TG), apoB and apoAI, glycosylated haemoglobin (HbA1c) and glutamicacid decarboxylase antibodies (GADA). Low-density lipoproteincholesterol (LDLC) and non-HDLC (NHDLC) were calculated. Wecompared values in subjects aged 15–50 y from the UnitedStates National Health and Nutrition Examination Survey (NHANES).

Results: Median age and duration of diabetes were 38 (range 14–45)and 4 (0–24) y. Men had significantly higher TC, TG, NHDLC,TC/HDLC, apoB/AI and NHDLC/apoB, and lower apoAI than women.Compared with the reference group, patients with type 1 diabeteshad lower TG, apoB:apoAI and HDLC:apoAI, and higher HDLC andapoAI. Patients with type 2 diabetes had higher TG, TC, LDLC,NHDLC, TC:HDL, apoB, apoAI and apoB:apoAI, and lower HDLC, LDLC:apoBand HDLC:apoAI. Among patients with type 2 diabetes, 54% hadhigh apoB (>1.2 g/L) and 33% also had high TG (>1.5 mmol/L).Measures of obesity (body mass index and waist circumference)were weakly correlated with lipid and apoprotein parameters,suggesting a modest contribution to dyslipidaemia.

Conclusions: A large proportion of young adult Sri Lankan patients with type2 diabetes has a low LDLC:apoB and high apoB and/or TG, suggestingthat these patients are at increased risk of CVD.

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