Metabolic Syndrome Accompanied by Hypercholesterolemia Is Strongly Associated With Proinflammatory State and Impairment of Fibrinolysis in Patients With Type 2 Diabetes
Synergistic effects of plasminogen activator inhibitor-1 and thrombin-activatable fibrinolysis inhibitor
- Yoshimasa Aso, MD,
- Sadao Wakabayashi, MD,
- Ruriko Yamamoto, MD,
- Rika Matsutomo, MD,
- Kohzo Takebayashi, MD and
- Toshihiko Inukai, MD
- Department of Internal Medicine, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan
- Address correspondence and reprint requests to Yoshimasa Aso MD, Department of Internal Medicine, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minami-Koshigaya, Koshiagya, Saitama 343-8555, Japan. E-mail: yaso{at}dokkyomed.ac.jp
Abstract
OBJECTIVE—To determine whether plasma concentrations of thrombin-activatable fibrinolysis inhibitor (TAFI) in patients with type 2 diabetes were associated with components of metabolic syndrome (MS), including high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor (PAI)-1, and LDL cholesterol.
RESEARCH DESIGN AND METHODS—We studied 136 consecutive patients with type 2 diabetes. Diagnosis of MS was diagnosed by current criteria. Hypercholesterolemia (HC) was defined as serum LDL cholesterol >140 mg/dl (3.6 mmol/l) or treatment with a statin. For comparisons, diabetic patients were divided into four groups: those with no MS and no HC (n = 38), with MS but not HC (n = 39), with no MS but with HC (n = 26), and with both MS and HC (n = 33).
RESULTS—Considering all patients with type 2 diabetes, plasma PAI-1 was strongly associated with MS components such as BMI, triglyceride, alanine aminotransferase, a homeostasis model assessment of insulin resistance, and hs-CRP. Plasma TAFI only correlated positively and independently with LDL cholesterol. Plasma concentrations of plasmin-α2-antiplasmin complex (PAP), a measure of fibrinolytic activity in blood, showed a significant negative correlation with plasma PAI-1 but not TAFI. Diabetic patients with both MS and HC had the highest serum hs-CRP concentrations and the lowest plasma PAP concentrations.
CONCLUSIONS—LDL cholesterol is a main determinant of plasma TAFI in patients with type 2 diabetes. Coexistence of MS and HC synergistically accelerates inflammation and impairment of fibrinolysis via elevated concentrations of both TAFI and PAI-1, which inhibit fibrinolysis.
- CVD, cardiovascular disease
- hs-CRP, high-sensitivity CRP
- HC, hypercholesterolemia
- MS, metabolic syndrome
- PAI, plasminogen activator inhibitor
- PAP, plasmin-α2-antiplasmin complex
- TAFI, thrombin-activatable fibrinolysis inhibitor
Footnotes
-
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
-
- Accepted May 23, 2005.
- Received April 5, 2005.
- DIABETES CARE
