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COMPARATIVE STUDY OF SERUMLIPIDS AND FIBRINOGEN LEVELSIN DIABETES MELLITUS AND ITSCLINICAL SIGNIFICANCE ININDIAN POPULATION

J G Saluja*, M S Ajinkya**, Bhavna Khemani***
*Head of Dept. of Pathology; **Assoc. Prof. of Pathology; ***Chief Pathology Technician, CMPH Medical College, Mumbadevi Homoeopathic Hosp, Vile Parle (W), Mumbai.

1. The present study was conducted on impaired glucose tolerance and diabetes mellitus patients. 50 adult male and female age group between 45-60 years were studied in the Department of Pathology of Mumbadevi Homoeopathic Hospital and CMPH Medical College.

2. The aim of the study was to study plasma fibrinogen in impaired glucose tolerance and diabetes mellitus.

3. An attempt was also made to find correlation between fibrinogen levels and lipid profile.

4. Mean plasma fibrinogen level in control was 0.58 gm/l and in impaired glucose tolerance and diabetes mellitus was 1.4 gm/l and 0.75 gm/l respectively.

5. This difference in fibrinogen level in cases (IGT and DM) and control is statistically significant.

a fibrinogen level, which can increase coronary risk. Low fibrinogen level is associated with low coronary risk even when LDL is raised.

INTRODUCTION

Buchanan, a Scottish physician first described the presence of fibrinogen in body fluids. Von Rokitonsy[20], a pathologist described the role of fibrin from arterial blood in occlusive arterial disease.

Approximately fifty years before, the role of arterial thrombosis in myocardial infarction was established. Somewhere in 1980s, the role of lipids in the artherogenesis was focussed and Smith[9] from Scotland showed the importance of fibrinogen along with dyslipidaemia in the pathogenesis of atherosclerosis.

The plasma fibrinogen[17] level remained elevated after myocardial infarct mainly during recovery phase. This was proved by author Mac Donald.

In 1982-83 study of fibrinogen levels[14] were considered to be a risk factor of IHD. A multivariate analysis showed that fibrinogen was an independent risk factor. Gothenburg[3] study in 1984-85 found that there was a correlation between fibrinogen level, BP, total cholesterol and smoking.

Looking into the previous[16],[18],[19] literature mentioned above we had an impetus to study the level of fibrinogen and lipid levels in diabetes mellitus and impaired glucose tolerance.

MATERIAL AND METHODS

50 cases of adult male and female in age group 45-60 years were selected for study.

All of them were diabetic and some had impaired glucose tolerance.

10% of the above patients had H/O Diabetes mellitus in family with either mother or father suffering.

30% of the above patients had H/O smoking and chewing tobacco with betelnuts. Average weight in kilos ranging from 50-70% kilo and height in cms 130 cms to 180 cms.

12% of them had an H/O IHD in past.

10% had H/O consuming mild to moderate alcohol occasionally.

Fig. 1
Fig. 1


Fig. 2
Fig. 2 :


Fig. 3
Fig. 3 :


Fig. 4
Fig. 4 :



Table Result in %
Group Mean
F
BSL
PP
Mean
LDL
%LDL
Test
Mean
FIB
%FIB
T
Control
(30)
88.32 118.34 100.3 36% 0.58 8%
Imp.
GTT(15)
112.58 193.13 141.5 26.6% 1.4 66%
DM(30) 229.97 316.93 121.06 16.6% 0.75 20%
  • Control GP - All were having fibrinogen level within normal limits.
  • PIH IHD - Few were having ˆ levels of fibrinogen. Few were having normal levels.
Those who were having high levels had diabetes mellitus.
  • 1. Significant variation in fibrinogen level in control group and DM group.
  • 2. Fibrinogen level and LDL chol. relationship, some high or low.
  • Control GP patients were healthy in age groups 45-60.
  • Few of them had fibrinogen level higher side of normal.

 

The blood glucose estimation carried by standard GOD POD Method.

Simultaneously lipid profile and fibrinogen was carried out by standard autoanalyser and spectrophotometric method.

The results were tabulated as follows:

Fibrinogen Level Control Group

NR --> 0.2 - 0.5 gm/dl

1.50 --> average level

Age group

45-60 years 0.2 - 0.45 gm/dl

Fibrinogen Level in Impaired Glucose Tolerance

SD ±

Fibrinogen Level in Diabetes Mellitus

SD ±

DISCUSSION

Individuals with diabetes mellitus[8],[10] both NIDDM and IDDM are at an increased risk for cardiovascular morbidity and mortality compared to non diabetic subjects. The cardiac dysfunction in diabetes can be either atherosclerotic coronary artery disease. Cardiac autonomic neuropathy,7 diabetic cardiomyopathy.

In this review we shall discuss the results of experimental work on 50 patients carried out in Mumbadevi Homoeopathic Hospital on clinic based studies.

Hyperlipidaemia has been found in approximately 60% of all diabetic patients and in impaired glucose tolerance. In diabetic and IGT patients, the lipid abnormalities include low HDL cholesterol, elevated VLDL, elevated LDL and triglycerides which contribute to IHD. In addition there are alterations in a lipoprotein composition.

It has been suggested or noted that raised plasma insulin levels[5,6] with insulin resistance appears to be an atherogenic factor.

Insulin stimulate cholesterol[4] synthesis in smooth muscle cells and macrophages of the arterial walls, stimulates the proliferation and migration of smooth muscle cells. It also enhances the binding of LDL to smooth muscle cells and macrophages. Even proinsulin and insulin like molecules have been shown to be probably better associated with the risk in NIDDM patients.

The fibrinogen levels16 in males were higher than in females. Similarly in control group, mean plasma fibrinogen levels in males and females were done.

The difference in plasma fibrinogen levels with sex was insignificant. Plasma fibrinogen levels11,12,13,15 are modified by many factors like smoking, moderate alcohol, overweight and HRT, all result in decreased plasma fibrinogen levels. Many drugs have shown to decrease plasma fibrinogen levels viz., Fibrates Ticlopidine.

All the above factors were considered while conducting the study and all patients were off, the above mentioned factors. We found a significant variation of values in fibrinogen.

It has been observed that fibrinogen levels in crease with age.[16] A prospective study of Laharrange F et al showed a significant higher values in subjects over 60 years of age. In our study, in the control group, plasma fibrinogen levels increased with increasing age. But in the case group, no significant correlation was found.

As such in diabetes mellitus patients, the blood viscosity and red cell deformability is increased which favours the process of thrombosis. This is attributed to increase in fibrinogen level in plasma. The high levels of fibrinogen predispose to ischaemic heart disease through different pathways mainly the development of atherosclerotic plaque, platelet aggregation and as a substrate in coagulation scheme. The fibrin deposit stabilises the adherence of thrombotic mass.

The values obtained in our study shows that most of the diabetics have high levels of LDL cholesterol along with moderate elevation of fibrinogen in 20% of patients. Few - 11% of patients showed mild rise in fibrinogen level. It has also been observed from this study that high levels of fibrinogen increases the productive power of high serum LDL cholesterol which increases the risk of ischaemic heart diseases.

Fig. 5
Fig. 5 :

The individuals who showed mild increase in fibrinogen[1],[2],[7] level also had raised LDL cholesterol. We also compared the level of fibrinogen in patients who had a past H/O IHD and/or F/H CAD. There was a significant correlation of IHD and fibrinogen levels.

Finally we noted that in our experimental study, there is a significant difference of fibrinogen level in DM and control group. So we would enlighten to stress that high level of fibrinogen is an independent factor for risk of IHD which means early intervention to control diabetes mellitus and reduce risk factors.

But still we would propose to have a large scale study in order to prove fibrinogen as an independent predictor of IHD as CAD are contributed to many environmental parameters.


REFERENCES
  1. Woodhouse PR, et al. Seasonal variations of plasma fibrinogen and factor VII activity in the elderly, winter infections and death from cardiovascular disease.
  2. Wilson TW. Association between plasma fibrinogen concentration and five socioeconomic indices in the Kuppio Ischaemic Heart disease - Risk factor study.
  3. Landin K Tengborn L, et al. Elevated fibrinogen and plasminogen activator inhibitor in hypertension are related to metabolic risk factor for cardio vascular disease. J Intern Med 1990; 8 : 227-73.
  4. Fein FS. Heart disease in diabetes Cardiovasc. Rev Rep 1982; 3 : 877-93.
  5. Kannel WB, McGee DL. Diabetes and cardiovascular disease the Framingham study. JAMA 1979; 241 : 2035-8.
  6. Fein FS, J Heart disease in Rifkin H, Porte D Jr. editors, Diabetes mellitus theory and practice, New York, Elsevier Science Publishers. 1990; 812-3.
  7. Jensen T Deekert T. Abnormalities in plasma concentration of lipoproteins and fibrinogen in type 1 diabetic patients with increased urinary albumin excretion. Diabetologia 1988; 31 : 142-5.
  8. Tagournis M. Interaction of diabetes with hypertension and lipids patients at high risk. Am J Med 1989; 86 (Suppl 1b) : 50-4.
  9. Smith EB. Fibrinogen fibrin and the arterial wall. Eur Heart J 1995; 16 (Suppl 1A) : 11-5.
  10. Amanda JL, et al. Fibrinogen in relation to personal history of prevalent hypertension, Diabetes, stroke, intermittent claudication, coronary heart disease and family history. Br Heart Journal 1995; 69 : 338-92.
  11. Barasch E, et al. Plasma Fibrinogen level and their correlates in 6457 coronary heart disease patients. J Clinical Epidemiol 1995; 148 (6) : 757-65.
  12. Crener, et al. Fibrinogen a coronary risk factor. Diagn Labour 1992; 42 : 28.
  13. Ernst E. Fibrinogen its emerging role as a cardiovascular risk factors and review. Angiology 1994; 45 (2) : 87-93.
  14. Ernst E. The role of fibrinogen as cardiovascular risk factor. Atherosclerosis 1993; 100 : 1-12.
  15. Folsom AR. Plasma fibrinogen levels and correlates in young adults. Am J Epidemiol 1993; 138 : 1023-26.
  16. Hamilton, et al. Age and Plasma fibrinogen. J Clin Path 1964; 27 : 327.
  17. Holler L, et al. Plasma fibrinogen as a risk factor in coronary heart disease. Atherosclerosis and Thrombosis 1991; 11 (2) : 344-50.
  18. Kannel WB, et al. Diabetes fibrinogen and risk of cardiovascular disease. A Framingham experience. Am Heart J 1990; 120 (3) : 672-6.
  19. Lars Moller, et al. Plasma fibrinogen and IHD risk factors. Arteriosclerosis and Thrombosis. 1991; 11 : 344-50.
  20. Lowe GDO. Fibrinogen and cardiovascular disease : historical introduction. Eur Heart J 1950 : 16 (Suppl A) : 25-30.

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