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The Prevalence Rate of Peripheral Arterial Disease in Type 2 Diabetes Mellitus and
In this study, no significant correlation was found
betweenHDL levels andPAD.This result supports stud-ies by Kazunari et al,5Asakawa et and Gregor et a1,*who did not find a significant correlation between HDLlevels and PAD in type 2 diabetes mellitus. O'Neal on
the other hand, found a significant correlation betweenthe two conditions?HDL carries cholesterol from peripheral tissues
through the plasma to the liver to be converted into fatty
acids and then excreted through the bile duct. Thus, HDL
has an anti-atherogenic characteristic. Reverse choles-
terol transport occurs when cholesterols leave the cell
and enters a more dense HDL subclass. In this case,
lecithin cholesterol acyl transferase (LCAT) esterifizes
the cholesterol particle of HDL by transferring unsatur-
ated fatty acids (linoleats from lesithin) into cholesterol
to form cholesterol esters. HDL-derived cholesterol es-
ters are immediately transferred to the liver through 2
mechanisms, LDL receptor uptake in the liver, and bybeing transferred into VLDL by cholesterol ester trans-ferase proteins (CTEPs).These cholesterol esters wouldthen also be sent to the liver to be excreted. These
mechanisms thus inhibit atherogenesis. In this study, there
was no significant correlation between HDL cholesterollevels in type 2 diabetes mellitus with or without PAD.
The reason for the lack of correlation is that in this study,no analysis was performed on weight reduction, calorie
restriction, or activity. Weight reduction, calorie restric-
tion, and increased activity could increase HDL levels.In type2diabetes mellitus, administration of insulin andoral anti-diabetic agents do not play much of a role in
increasing HDL levels.20Hypemiglyceride is often found in type 2 diabetesmellitus. In this study, there was no significant correla-tion between triglyceride levels and PAD. This result
supports studies conducted by O'Neal et a1,6 Asakawaet a1,8and Gregor et al? Increased triglyceride levels intype 2 diabetes mellitus through 3 mechanisms. The firstmechanism is through the secretion of large particle
cretion by the liver. The V
has a smaller particle size
In this mechanism, Apo B
thus causing hypertriglycehydrolyzed by LPL, increas
LDL levels. In type 2diabe
production by the liver pla
triglyceride levels compar
Obesity has a close c
tance and type 2diabetes m
aside from the presence o
hypertension and hyperinsstudy, the chi square test d
lation between a BMI of o
lence of PAD, which is in
et a1,6Asakawa et a1,8andlogistic regression analysi
a significant correlation w
over 25 kg/m2and the preIncreased prevalence
not only associated with in
to ethnic and racial backgr
ciated with insulin resistan
sity. Visceral obesity could
hip ratio. Waist to hip ratio
ccra! obesity compared tofrom adipose tissue is th
and insulin resistance. Vi
role, since it is metabolica
subcutaneous fat, particul
ids. Free fatty acids incre
and hyperglycemia during
free fatty acids in the perip
lin action in tissue^.^'Hyperglycemia could
the polyol pathway, auto-o
These three processes in
stimulate the release of fre
causes reduced NO releas
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