부산대학교 도서관

In order to elucidate the atherogenicity of diabetes mellitus (DM), we examined the incidence of coronary artery disease (CAD) and the characteristics of lipoprotein abnromalities in patients with heterozygous familial hypercholesterolemia (FH) accompanied with DM or impaired glucose tolerance (IGT). Fifteen patients (10%) out of 150 patients with FH over 40 years old were accompanied with DM and 27 patients (18%) by IGT. The incidence of CAD was high (43%) in the FH group without DM or IGT, as we had already reported. However, the combination of DM or IGT with FH was associated with a further increase in CAD incidence up to 80% and 59%, respectively. In addition, the incidence of myocardial infarctions was remarkably higher (67%) in the DM group compared with that in the non-DM/IGT group (19%) and that in the IGT group (30%). The CAD extent score in FH patients with CAD was higher in the DM group and in the IGT group than in the non-DM/IGT group. The incidence of lesions in the distal coronary arteries was significantly higher in the DM group than in the non-DM/IGT group, while there was no difference in the prevalence of proximal and middle lesions among the three groups.Serum triglycerides levels were significantly higher in the DM group and the IGT group than in the normal group, while total cholesterol levels were not significantly different. When lipoproteins were analyzed by polyacrylamide gel electrophoresis, the frequency of midband appearance, which implies an increase of remnant lipoproteins, was significantly higher in the DM group and in the IGT group (DM: IGT: normal =87%: 72%: 29%). An ultracentrifugation analysis of the lipoproteins revealed that the intermediate density lipoprotein cholesterol was increased in the DM and IGT group. This data suggests that remnant lipoproteins, in addition to a high concentration of LDL in FH patients with DM and IGT, may accelerate coronary atherosclerosis in patients with FH.