Total-to-HDL Cholesterol Ratio and Visceral Adiposity Index Correlation in Type Two Diabetics with or without Ischemic Stroke

Karina Rahma Meidiarti, Phey Liana✉, Swanny Swanny, Tungki Pratama Umar
DOI: https://doi.org/10.25077/mka.v44.i7.p471-480.2021

Abstract

Objective: The study aims to analyze clinical and laboratory data differences, also the correlation of Visceral Adiposity Index (VAI) with other observed parameters in type 2 diabetics with or without ischemic stroke.

Methods: This study was conducted as analytic observational study with cross-sectional design. Clinical data were directly collected from patients, followed by laboratory data collection. There was a comparison (Mann-Whitney or independent T-tests) and correlation analysis (Pearson or Spearman).

Results: In the ischemic stroke group, the total-to-HDL cholesterol ratio and VAI were significantly higher (p=0.033 and 0.002, respectively) than the non-ischemic stroke group. The total-to-HDL cholesterol ratio and VAI had a significant correlation (p<0.001). Clinical (WC and VAI) and laboratory data (total cholesterol, triglyceride, LDL-C, and total-to-HDL cholesterol ratio) differ significantly in type 2 diabetics with or without ischemic stroke.

Conclusion: In both diabetes groups, with or without ischemic stroke, there was a significant correlation between VAI and the total-to-HDL cholesterol ratio.

Keywords

Dyslipidemia; Ischemic stroke; Metabolic syndrome; Type 2 diabetes mellitus; Visceral obesity

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References

Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020;10(1):14790. doi: 10.1038/s41598-020-71908-9.

International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels: International Diabetes Federation; 2019.

Nugroho PS, Tianingrum NA, Sunarti S, Rachman A, Fahrurodzi DS, Amiruddin R. Predictor risk of diabetes mellitus in Indonesia, based on national health survey. Malaysian J Med Heal Sci. 2020;16(1):126–30.

Papatheodorou K, Banach M, Bekiari E, Rizzo M, Edmonds M. Complications of Diabetes 2017. J Diabetes Res. 2018;2018:3086167. doi: 10.1155/2018/3086167.

Cade WT. Diabetes-related microvascular and macrovascular diseases in the physical therapy setting. Phys Ther. 2008;88(11):1322–35. doi: 10.2522/ptj.20080008.

Wang CCL, Hess CN, Hiatt WR, Goldfine AB. Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes Mellitus - Mechanisms, Management, and Clinical Considerations. Circulation. 2016;133(24):2459–502. doi: 10.1161/CIRCULATIONAHA.116.022194.

Wong ND, Nelson JC, Granston T, Bertoni AG, Blumenthal RS, Carr JJ, et al. Metabolic Syndrome, Diabetes, and Incidence and Progression of Coronary Calcium. JACC Cardiovasc Imaging. 2012;5(4):358–66. doi: 10.1016/j.jcmg.2011.12.015.

Marso SP, Mercado N, Maehara A, Weisz G, Mintz GS, McPherson J, et al. Plaque Composition and Clinical Outcomes in Acute Coronary Syndrome Patients With Metabolic Syndrome or Diabetes. JACC Cardiovasc Imaging. 2012;5(3_Supplement):S42–52. doi: 10.1016/j.jcmg.2012.01.008.

Katakami N. Mechanism of development of atherosclerosis and cardiovascular disease in diabetes mellitus. J Atheroscler Thromb. 2017;RV17014. doi: 10.5551/jat.RV17014.

Schofield JD, Liu Y, Rao-Balakrishna P, Malik RA, Soran H. Diabetes Dyslipidemia. Diabetes Ther. 2016;7(2):203–19. doi: 10.1007/s13300-016-0167-x.

Acevedo M, Krämer V, Tagle R, Corbalán R, Arnaíz P, Berríos X, et al. Total/HDL cholesterol ratio and non HDL cholesterol as predictors for increased intima media thickness. Rev Med Chil. 2012;140(8):969–76. doi: 10.4067/S0034-98872012000800001.

Orozco-Beltran D, Gil-Guillen VF, Redon J, Martin-Moreno JM, Pallares-Carratala V, Navarro-Perez J, et al. Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study. PLoS One. 2017;12(10):e0186196. doi: 10.1371/journal.pone.0186196.

Zhang Y, Tuomilehto J, Jousilahti P, Wang Y, Antikainen R, Hu G. Total and high-density lipoprotein cholesterol and stroke risk. Stroke. 2012;43(7):1768–74. doi: 10.1161/STROKEAHA.111.646778.

Chen Y, Jiang J, Shi J, Chen X, Xu Y. Association of Visceral Fat Index and Percentage Body Fat and Anthropometric Measures with Myocardial Infarction and Stroke. J Hypertens. 2016;5(235):1095–2167. doi: 10.4172/2167-1095.1000235.

Kavaric N, Klisic A, Ninic A. Are visceral adiposity index and lipid accumulation product reliable indices for metabolic disturbances in patients with type 2 diabetes mellitus? J Clin Lab Anal. 2018;32(3):e22283. doi: 10.1002/jcla.22283.

Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, et al. Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010;33(4):920–2. doi: 10.2337/dc09-1825.

Badan Penelitian dan Pengembangan Kesehatan. Laporan Nasional Riskesdas 2018. Jakarta: Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan; 2019.

Khoury JC, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, Adeoye O, et al. Diabetes Mellitus: A Risk Factor for Ischemic Stroke in a Large Biracial Population. Stroke. 2013;44(6):1500–4. doi: 10.1161/STROKEAHA.113.001318.

Kissela BM, Khoury J, Kleindorfer D, Woo D, Schneider A, Alwell K, et al. Epidemiology of ischemic stroke in patients with diabetes: the greater Cincinnati/Northern Kentucky Stroke Study. Diabetes Care. 2005;28(2):355–9. doi: 10.2337/diacare.28.2.355.

Yao M-F, He J, Sun X, Ji X-L, Ding Y, Zhao Y-M, et al. Gender differences in risks of coronary heart disease and stroke in patients with type 2 diabetes mellitus and their association with metabolic syndrome in China. Int J Endocrinol. 2016;2016:8483405. doi: 10.1155/2016/8483405.

Hyvärinen M, Tuomilehto J, Laatikainen T, Söderberg S, Eliasson M, Nilsson P, et al. The impact of diabetes on coronary heart disease differs from that on ischaemic stroke with regard to the gender. Cardiovasc Diabetol. 2009;8(1):1–5. doi: 10.1186/1475-2840-8-17.

Zhao W, Katzmarzyk PT, Horswell R, Wang Y, Johnson J, Hu G. Sex differences in the risk of stroke and HbA 1c among diabetic patients. Diabetologia. 2014;57(5):918–26. doi: 10.1007/s00125-014-3190-3.

Policardo L, Seghieri G, Francesconi P, Anichini R, Franconi F, Seghieri C, et al. Gender difference in diabetes-associated risk of first-ever and recurrent ischemic stroke. J Diabetes Complications. 2015;29(5):713–7. doi: 10.1016/j.jdiacomp.2014.12.008.

Wan H, Wang Y, Xiang Q, Fang S, Chen Y, Chen C, et al. Associations between abdominal obesity indices and diabetic complications: Chinese visceral adiposity index and neck circumference. Cardiovasc Diabetol. 2020;19(1):1–12. doi: 10.1186/s12933-020-01095-4.

Knowles KM, Paiva LL, Sanchez SE, Revilla L, Lopez T, Yasuda MB, et al. Waist circumference, body mass index, and other measures of adiposity in predicting cardiovascular disease risk factors among Peruvian adults. Int J Hypertens. 2011;2011:931402. doi: 10.4061/2011/931402.

Laily SR, Martini S, Choirul A, Flourentina E. Abdominal Obesity as a Risk Factor of Ischemic Stroke Incidence in Lamongan Distric, Indonesia. Malaysian J Med Heal Sci. 2020;16(Supp 1):88–93.

Wang H, Chen Y, Guo X, Chang Y, Sun Y. Usefulness of cardiometabolic index for the estimation of ischemic stroke risk among general population in rural China. Postgrad Med. 2017;129(8):834–41. doi: 10.1080/00325481.2017.1375714.

Yu Y, Zhang F, Yan X, Zhang P, Guo Z, Yang Y. Visceral adiposity index and cervical arterial atherosclerosis in northeast China: a population based cross‐sectional survey. Eur J Neurol. 2021;28:161–171. doi: 10.1111/ene.14513.

Nam K-W, Kwon H-M, Jeong H-Y, Park J-H, Kwon H, Jeong S-M, et al. Visceral adiposity index is associated with silent brain infarct in a healthy population. Sci Rep. 2020;10(1):1–7. doi: 10.1038/s41598-020-74454-6.

Randrianarisoa E, Lehn-Stefan A, Hieronimus A, Rietig R, Fritsche A, Machann J, et al. Visceral adiposity index as an independent marker of subclinical atherosclerosis in individuals prone to diabetes mellitus. J Atheroscler Thromb. 2019;26(9):47274. doi: 10.5551/jat.47274.

Oh S-K, Cho A-R, Kwon Y-J, Lee H-S, Lee J-W. Derivation and validation of a new visceral adiposity index for predicting visceral obesity and cardiometabolic risk in a Korean population. PLoS One. 2018;13(9):e0203787. doi: 10.1371/journal.pone.0203787.

Ferreira FG, Juvanhol LL, da Silva DCG, Longo GZ. Visceral adiposity index is a better predictor of unhealthy metabolic phenotype than traditional adiposity measures: results from a population-based study. Public Health Nutr. 2019;22(9):1545–54. doi: 10.1017/S136898001800335X.

Sujatha R, Kavitha S. Atherogenic indices in stroke patients: A retrospective study. Iran J Neurol. 2017;16(2):78.

Zhou P, Liu J, Wang L, Feng W, Cao Z, Wang P, et al. Association of small dense low-density lipoprotein cholesterol with stroke risk, severity and prognosis. J Atheroscler Thromb. 2020;27:53132. doi: 10.5551/jat.53132.

Kothari V, Stevens RJ, Adler AI, Stratton IM, Manley SE, Neil HA, et al. Risk of Stroke in Type 2 Diabetes Estimated by the UK Prospective Diabetes Study Risk Engine (UKPDS 60). Stroke. 2002;33:1776–81. doi: 10.1161/01.str.0000020091.07144.c7.

Liu X, Yan L, Xue F. The associations of lipids and lipid ratios with stroke: A prospective cohort study. J Clin Hypertens. 2019;21(1):127–35. doi: 10.1111/jch.13441.

Devi SA, Jyothi B. Dyslipidemia in metabolic syndrome: An overview of lipoprotein-related disorders. Int J Cardiol Lipidol Res. 2017;4(1):6–15.

Sukkriang N, Chanprasertpinyo W, Wattanapisit A, Punsawad C, Thamrongrat N, Sangpoom S. Correlation of body visceral fat rating with serum lipid profile and fasting blood sugar in obese adults using a noninvasive machine. Heliyon. 2021;7(2):e06264. doi: 10.1016/j.heliyon.2021.e06264.

Gutin B, Johnson MH, Humphries MC, Hatfield‐Laube JL, Kapuku GK, Allison JD, et al. Relationship of visceral adiposity to cardiovascular disease risk factors in black and white teens. Obesity. 2007;15(4):1029–35. doi: 10.1038/oby.2007.602.

Air EL, Kissela BM. Diabetes, the metabolic syndrome, and ischemic stroke: epidemiology and possible mechanisms. Diabetes Care. 2007;30(12):3131–40. doi: 10.2337/dc06-1537.

Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol. 2014;13(1):1–10. doi: 10.1186/s12933-014-0146-3.

Holman RR, Coleman RL, Shine BSF, Stevens RJ. Non-HDL cholesterol is less informative than the total-to-HDL cholesterol ratio in predicting cardiovascular risk in type 2 diabetes. Diabetes Care. 2005;28(7):1796–7. doi: 10.2337/diacare.28.7.1796.



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