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Role of relationship between HbA1c, fibrinogen and HDL-cholesterol on cardiovascular disease in patients with type 2 diabetes mellitus

  • Antonio Pacilli
    Affiliations
    Unit of Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza”, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Italy
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  • Salvatore De Cosmo
    Affiliations
    Unit of Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza”, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Italy
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  • Author Footnotes
    1 These two authors equally supervised the entire study.
    Vincenzo Trischitta
    Footnotes
    1 These two authors equally supervised the entire study.
    Affiliations
    Research Unit of Diabetes and Endocrine Diseases, Scientific Institute “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy

    Department of Experimental Medicine, “Sapienza” University, Rome, Italy
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  • Author Footnotes
    1 These two authors equally supervised the entire study.
    Simonetta Bacci
    Correspondence
    Corresponding author. Tel.: +39 0882410626; fax: +39 0882410627.
    Footnotes
    1 These two authors equally supervised the entire study.
    Affiliations
    Unit of Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza”, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Italy
    Search for articles by this author
  • Author Footnotes
    1 These two authors equally supervised the entire study.

      Abstract

      Objective

      To assess the impact of relationship between glycated hemoglobin (HbA1c), fibrinogen and HDL-cholesterol (HDL-c) on cardiovascular disease in type 2 diabetes.

      Methods

      We investigated i) the relationship of HbA1c, fibrinogen and HDL-c in 375 coronary artery disease (CAD)-negative and 320 CAD-positive diabetic patients and ii) the association between clustering of these three factors and incident major cardiovascular events in 317/320 CAD-positive patients.

      Results

      i) The relationships between HbA1c and both fibrinogen and HDL-c and between HDL-c and fibrinogen were significant only in CAD-positive patients (β = 10.655, p = 0.002; β = −1.056, p = 0.013; β = −1.751, p = 0.000008, respectively); ii) patients with worse-than-median levels of the three factors showed higher risk for major cardiovascular events than others (HR: 2.22, 95%CI = 1.23–4.02, p = 0.008). Both findings were independent of LDL-c, blood pressure or ongoing therapies.

      Conclusion

      Our findings suggest interwoven actions of poor glycemic control, low grade inflammation and low HDL-c on atherosclerotic processes in type 2 diabetes.

      Highlights

      • In type 2 diabetes HbA1c, fibrinogen and HDL-c are interrelated only in CAD patients.
      • Such correlations are independent of LDL-c, blood pressure and ongoing treatments.
      • Clustering of high HbA1c, high fibrinogen and low HDL-c predict cardiovascular events.
      • These 3 factors might exert an interwoven role on atherosclerosis in type 2 diabetes.

      Keywords

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