Lipids, Diabetes and Coronary Artery Disease in Indians

Diabetes mellitus (DM) is a protean metabolic disorder that adversely affects the vascular channels of the body leading to occlusive vascular events like coronary artery disease (CAD) and peripheral vascular disease (PVD).Besides the diabetic state, higher levels of triglycerides, lower HDL cholesterol and more of glycated Apo B100 contributes to the excess of atherogenesis in these subjects. In Indian subjects with DM the lipid profile and pattern is greatly influenced by the ethnic origin, food habits, nutritional status and lifestyle influences. There has been a quantum increase in the incidence of CAD amongst urbanites while the picture in rural India has changed very little, suggesting the major impact of lifestyle modifications on lipid profiles and the deleterious effect of the latter in causing accelerated and more extensive CAD as evident angiographically. These alterations in lipid profiles precede the events much in advance and are also prevalent in the adolescent siblings of patients with CAD. In our social setup, it is the nurture which has been the main determining factor than the nature per se. Conventional dyslipidemia of hypercholesterolemia with high LDLc may not be the commonly found abnormalities in our subjects and due attention should be given to Type IV and Type IIb hyperlipidemias as cause of excessive CAD in our population groups besides tight glycemic control to avert increased glycation of functional proteins and apoproteins. Raised triglyceride levels can be used as surrogate lipid markers for CAD in the susceptible population and families.