Int J Diabetes & Metab (2010) 18:49-54 49 The roles of apo E genotype, gender and adipokines in blood plasma lipids in Caucasians with well-controlled type 2 diabetes Douglas E. Barre 1 , Kazimiera A. Mizier-Barre 2 , Odette Griscti 3 , and Kevin Hafez 4 Department of Health Studies 1 , Department of Biology 2 , School of Nursing 3 Cape Breton University Sydney, Nova Scotia, Canada; Department of Family Medicine, King Faisal Specialist Hospital & Research Center, Riyadh , Saudi Arabia 4 ____________________________________________________________________________________ Abstract Cape Breton Island has among the highest levels of type 2 diabetes in Canada and therefore the risk of associated coronary atherosclerosis-induced myocardial infarction is also very high. Fasting blood serum lipid concentrations are important measures of coronary atherosclerosis disease risk in type 2 diabetics. Apolipoprotein E alleles and genotypes, as well as the adipocytokines, leptin and adiponectin modify fasting blood serum lipid levels and thus the degree of atherosclerosis which may be assessed in part by c-reactive protein (CRP). Control of blood lipid levels is critical to reducing the risk of myocardial infarction. It was hypothesised that there would be no gender differences in myocardial infarction risk including CRP levels and at least some of the lipid levels including their modulating levels of apolipoprotein alleles and genotypes, leptin and adiponectin. The purpose of this study was to assess this hypothesis. Females had significantly higher levels of high density lipoprotein cholesterol (HDL-c) and its atherogenic subfraction HDL 2 -c while at the same time having higher levels of HDL 3 - c. Serum free fatty acids levels were significantly higher in females as was the leptin level. There were no gender differences in elevated total cholesterol (TC), low density lipoprotein-cholesterol (LDL-c), small dense (sd) LDL-c, triglycerides, lipoprotein(a), adiponectin and CRP and the ratios of HDL-c: TC and HDL-c: LDL-c. By trend or significantly, Apo E genotypes and allele presence correlated variously by gender with some lipid levels. Thus despite the higher degree of antiatherogenic HDL-c and HDL 2 -c in females, this was not manifested in lesser atherosclerotic severity as assessed by CRP. This may be due to the fact that HDL-c and HDL 2 -c were low as was ratio of HDL-c: TC and HDL-c: LDL-c. Thus it is concluded that apo E genotype, lipid levels and the ratios of HDL-c: TC and HDL-c: LDL-c equally favour atherosclerosis in both males and female type 2 diabetics in Cape Breton and more aggressive intervention is required to ameliorate the substantial risk of atherosclerosis induced myocardial infarction presented by these lipid profiles. However, this was only a small study and a larger study would more definitively address the risk of myocardial infarction in both males and females on Cape Breton. Keywords: Human, fasting serum lipids, leptin, adiponectin, clinical targets, type 2 diabetes Introduction Cape Breton Island in the province of Nova Scotia, Canada suffers from among the highest rates of type 2 diabetes in Canada, the consequences of which are seen in the overall economy and in the competition for healthcare dollars with other health issues. Consequently it is important to control this disease as much as possible so as to reduce its economic and social impact. There are no reports to date regarding the gender equity of management of the features of dislipidemia, such information being of clear importance for the medical, economic and social impacts of this disease. Dyslipidemia is a feature of type 2 diabetes that contributes significantly to the major cause of death in these patients, atherosclerosis-induced myocardial infarction. 1,2 All references to dyslipidemia herein refer to blood plasma or ____________________________________ Received on: 11/11/2009 Accepted on 3/7/2010 Correspondence to: Ed Barre, Department of Health Studies, Cape Breton University, P.O. Box 5300, Sydney, Nova Scotia, B1P-6L2 Canada. E-mail: ed_barre@cbu.ca serum concentrations in fasted patients. Dyslipidemia features elevated triglyceride concentrations, small dense LDL-c, and in some patients elevated total cholesterol and low density lipoprotein-cholesterol (LDL-c). 2-6 Elevated high density lipoprotein 3 -cholesterol (HDL 3 -c) concentrations may also feature. As well there are decreased fasting blood plasma concentrations of high density lipoprotein-cholesterol (HDL-c), high density lipoprotein 2 - cholesterol (HDL 2 -c). 3 As triglycerides rise, HDL-c and HDL 2 -c fall while small dense LDL-c also rises. This profile is pro-atherogenic and thus a promoter of plaque formation. 3 Free fatty acid concentrations also rise in type 2 diabetes contributing to increased blood plasma glucose concentrations 7 further exacerbating the dyslipidemia. As small dense LDL-c and LDL-c rise there is a greater influx of cholesterol into the arterial wall. 3 Low blood serum fasting levels of adiponectin and elevated leptin contribute to dyslipidemia. 8-19 However, such relationships are in dispute. 20 C-reactive protein (CRP) is a measure of the extent of atherosclerosis and therefore to some degree the risk of myocardial infarction. 21-22