Levels and correlation between glycated hemoglobin A1c and lipid parameters in diabetic patients recovered from acute myocardial infarction

Introduction. Diabetes mellitus is an important risk factor for coronary artery disease, related to its high prevalence. Risk of developing coronary heart disease in patients with diabetes is 2 to 4 times higher then in non-diabetic patients and correlates with the level of glycated hemoglobin A1c (HbA1c) and severity of dyslipidemia. There is a significant correlation between the level of HbA1c, severity of coronary artery disease and the number of diseased vessels in patients with type 2 diabetes and myocardial infarction Objective. The aim was to determine the level of HbA1c and estimate its correlation with lipid parameters and multivessel coronary artery disease in patients with type 2 diabetes mellitus recovered from myocardial infarction. Method. Study included 42 patients, 24 (57%) men and 18 (43%) women, mean age 65.6 ± 4.6 years, with type 2 diabetes mellitus, recovered from acute myocardial infarction and angiographically confirmed multivessel coronary disease. Levels of HbA1c, total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, cholesterol ratio (total cholesterol/HDL) and atherosclerosis index (LDL/HDL) were determined in each patient and correlation between them was examined. Results. The average HbA1c was 8.66 ± 2.21%; total cholesterol 5.55 ± 1.28 mmoll/L; triglycerides 2:51 ± 1.54 mmol/L; LDL 3.32 ± 0.86 mmol/L; HDL 1 06 ± 0.23 mmoll/L; risk factors: total cholesterol/HDL ratio 5.72 ± 2.83; and atherosclerosis index (LDL/HDL) 3.41 ± 1.52. HbA1c shows a positive and statistically significant correlation with the levels of total cholesterol (r = 0.605, p <0.01), triglycerides (r = 0.678, p <0.01), LDL cholesterol (r = 0.375, p <0.01) and a negative highly significant correlation with HDL cholesterol (r = -0.579, p <0.01). There is a positive, statistically significant correlation between HbA1c levels and cholesterol ratio (r = 0.723, p <0.01) and between HbA1c and atherosclerosis index (r = 0.660, p <0.01). Linear regression equation for HbA1c and total cholesterol is y = 0.351x + 2.508, for HbA1c and triglycerides y = 0.471x - 1.572, for HbA1c and LDL cholesterol y = 0.146x + 2.062, for HbA1c and HDL cholesterol y = -1.578 + 0.06x, for HbA1c and cholesterol ratio y = 0.927x - 2.307, for HbA1c and LDL/HDL cholesterol y = 0.455x - 0.529. Conclusion. High levels of HbA1c and statistically significant correlation between HbA1c and lipid parameters in diabetic patients with two vessel and three vessel coronary artery disease recovered from myocardial infarction, indicate that HbA1c level is a significant marker and predictor of dyslipidemia and extensive coronary disease in these patients.