Glycemic Control and Non-Traditional Lipid Parameters in Non-Diabetics Undergoing Coronary Angiography – The Indian Scenario

Background: Diabetes is the primary risk factor for coronary heart disease and both represent high disease burden in the Indian population. Objective: This study was undertaken to identify independent risk factors and novel non-traditional lipid markers for coronary disease amongst Indian non-diabetics. Methodology: Prospective study in an urban tertiary-care hospital including 96 non-diabetic outpatients referred for coronary angiography. Waist/Hip circumference, BMI, lipid parameters and HbA1C, was measured. Angiograms were scored as per Friesinger-Index. AIP, AI and LCI were calculated from lipid variables. Results: Participants were aged 60.7±1.87 years, 70 were male. Friesinger-Index correlated well with HbA1c (r=0.378,p<0.01), TG(r=0.424,p<0.01), HDL (r=–0.267,p<0.01), TG/HDL ratio (r=0.465,p<0.01), AIP(r=0.465,p<0.01), AI(r=0.272, p<0.01), LCI(r=0.378,p<0.01) and Waist/Hip-Ratio(r=0.411,p<0.01), but not with BMI, Total Cholesterol or LDL. Participants were grouped as per severity of coronary lesions, (Friesinger-Index of <5, 5-10 and >10) and parameters were compared using One-way ANOVA or Kruskal-Wallis test. Significant differences were observed for Waist/Hip-Ratio(F=8.74,p<0.01), AIP(F=12.08,p<0.01), AI(F=5.76,p<0.01), LCI(H=7.88,p<0.05) HDL(F=4.73,p<0.05), TG(F=5.38,p<0.01), TG/HDL-Ratio(F=13.17,p<0.01) and HbA1c(F=7.97,p<0.01), but not for BMI, Total Cholesterol or LDL. Conclusion: Glycemic control even amongst non-diabetics contributes to coronary disease severity. Central Obesity or waist/hip-ratio assumes greater significance than BMI in the Indian population. Novel lipid parameters such as AIP, AI, TG/HDL ratio, and HDL and TG levels are more effective predictors than traditional parameters like LDL and Total Cholesterol.