Arquivos Brasileiros de Cardiologia (Feb 2009)
Transferências lipídicas para HDL em diabéticos tipo 2: associações com microalbuminúria, estatina e insulina Transferencias lipídicas hacia HDL en diabéticos tipo 2: asociaciones con microalbuminuria, estatina y insulina Lipid transfer to HDL in type-2 diabetic patients: associations with microalbuminuria, statin, and insulin
Abstract
FUNDAMENTO: O diabete melito tipo 2 (DM2) é um fator de risco isolado para coronariopatia, principalmente quando associado à microalbuminúria (MA). Alterações estruturais e funcionais das lipoproteínas não são totalmente esclarecidas nesse contexto. OBJETIVO: Avaliar a transferência de lípides para HDL (T) em pacientes DM2 e a associação com a presença da MA e com o tratamento com estatina ou insulina. MÉTODOS: Estudamos 33 pacientes com DM2 e 34 controles pareados para idade. Uma nanoemulsão lipídica artificial radiomarcada com ³H-Triglicéride (TG) e 14C-colesterol livre (CL) ou ³H-colesterol éster (CE) e 14C-fosfolípide (FL) foi incubada com plasma. A nanoemulsão e as lipoproteínas foram precipitadas, exceto a HDL, que teve sua radioatividade contada. RESULTADOS: A TFL (%) foi maior no grupo com DM2 que no grupo-controle (25,2±3,2 e 19,7±3,2 respectivamente; p FUNDAMENTO: La diabetes mellitus tipo 2 (DM2) es un factor de riesgo aislado para coronariopatía, principalmente cuando asociado a la microalbuminuria (MA). Alteraciones estructurales y funcionales de las lipoproteínas no están totalmente aclaradas en ese contexto. OBJETIVO: Evaluar no sólo la transferencia de lípidos hacia HDL (T) en pacientes DM2, sino también la asociación tanto con la presencia de la MA como con el tratamiento con estatina o insulina. MÉTODOS: Estudiamos a 33 pacientes con DM2 y 34 controles pareados para edad. Se incubó con plasma una nanoemulsión lipídica artificial radiomarcada con ³H-Triglicérido (TG) y 14C-colesterol libre (CL) o ³H-colesterol esterificado (CE) y 14C-fosfolípido (FL). Se procedió a la precipitación de la nanoemulsión y de las lipoproteínas, con excepción de la HDL, que tuvo su radioactividad contada. RESULTADOS: El valor de TFL (%) resultó mayor en el grupo con DM2 en confrontación con el grupo-control (25,2±3,2 y 19,7±3,2 respectivamente; p BACKGROUND: Type-2 diabetes mellitus (T2DM) is an isolated risk factor for coronary artery disease, especially when associated with microalbuminuria (MA). Structural and functional changes in lipoproteins have not yet been fully elucidated in this context. OBJECTIVE: To assess lipid transfer (T) to HDL in type-2 diabetic patients and its association with microalbuminuria and treatment with statins or insulin. METHODS: Thirty-three patients with type-2 diabetes mellitus and 34 age-matched control subjects were studied. A synthetic cholesterol-rich nanoemulsion radiolabeled with ³H- triglycerides (TG) and 14C-free cholesterol (FC) or ³H- cholesteryl ester (CE) and 14C-phospholipids (PL) was incubated with plasma. Both the nanoemulsion and lipoproteins were precipitated, except for HDL, which was counted for radioactivity. RESULTS: PLT (%) was higher in the T2DM group than in the control group (25.2 ± 3.2 and 19.7 ± 3.2 respectively; p < 0.001), as was free cholesterol (% FC): 9.1 ± 2.7 and 6.3 ± 1.5 respectively; p < 0.001. The diagnosis of microalbuminuria (MA) was not associated with changes in lipid transfers. Insulin therapy was associated with lower PLT rates: 23.5 ± 2.1 versus 26.1 ± 3.3; p = 0.018. Statin therapy, in turn, was associated with a drop in all lipid transfers - CET 3.5 ± 0.9; PLT: 23.8 ± 2.0; TGT: 3.9 ± 0.8; FCT: 7.4 ± 1.3 - as compared to the group that was not on statin therapy (CET: 5.9 ± 2.4; PLT: 26.9 ± 3.6; TGT: 6.4 ± 2.2; FCT: 11.1 ± 2.6). CONCLUSION:Type-2 diabetes mellitus increased lipid transfer to HDL particles, whereas statin therapy decreased all lipid transfers. The presence of MA was not associated with changes in lipid transfer.
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