The Relationship between the Leptin Concentration and the Small Dense Low Density Lipoprotein Cholesterol Concentration in Korean Type 2 Diabetic Patients

Wan Sub Shim; Hae Jin Kim; Eun Seok Kang; Yu Mie Rhee; Chul Woo Ahn; Sung Kil Lim; Hyun Chul Lee; Bong Soo Cha

doi:10.3803/jkse.2006.21.4.319

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Shim, Kim, Kang, Rhee, Ahn, Lim, Lee, and Cha: The Relationship between the Leptin Concentration and the Small Dense Low Density Lipoprotein Cholesterol Concentration in Korean Type 2 Diabetic Patients

Original Article

J Korean Soc Echocardiogr 2006;21(4):319-327.

Published online: 9 January 2006

DOI: https://doi.org/10.3803/jkse.2006.21.4.319

The Relationship between the Leptin Concentration and the Small Dense Low Density Lipoprotein Cholesterol Concentration in Korean Type 2 Diabetic Patients

Wan Sub Shim¹, Hae Jin Kim¹, Eun Seok Kang^1,², Yu Mie Rhee^1,², Chul Woo Ahn^1,², Sung Kil Lim^1,², Hyun Chul Lee^1,², Bong Soo Cha^1,²

¹Department of Internal Medicine, Yonsei University College of Medicine

²Institute of Endocrine Research, Yonsei University College of Medicine

Received 26 December 2005 Accepted 4 June 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background:

Leptin has been suggested as a possible cause of atherosclerotic disease. The small dense low-density lipoprotein cholesterol (LDL-C) has also been regarded as a new surrogate marker in atherosclerotic disease. The aim of this study was to evaluate the relationship between the leptin concentration and the small dense LDL-C concentration in Korean type 2 diabetic patients.

Methods:

One hundred-ninety one type 2 diabetic patients, who did not use any medication that could affect the concentration of lipid such as statin, fibrate, thiazolidinediones and corticosteroid, were enrolled in this study. We analyzed the relationship between leptin, the small dense LDL-C and the other metabolic parameters.

Results:

The small dense LDL-C concentrations were higher in the group with the highest tertile of the leptin value, both in males and females than those patients in the group with the lowest tertile of the leptin value. The small dense LDL-C concentrations were also higher in the group with the highest tertile of leptin divided by the BMI value both in males and females than those patients in the group with the lowest tertile of the leptin value. The leptin concentration was positively correlated with the small dense LDL-C, total cholesterol, triglyceride, LDL-C, insulin and HOMAIR values after adjusting for age, gender and BMI.

Conclusion:

The association between leptin and small dense LDL-C could be a factor that explains the association between leptin and cardiovascular disease.

Keywords: Leptin, Precipitation method, Small dense LDL, Type 2 diabetes mellitus

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Table 1.

Clinical characteristics of patients

	Total	Male	Female	P value
N	191	101	90
Age (years)	57.2 ± 11.2	55.2 ±12.1	59.4 ± 9.6	0.009
Duration of diabetes (years)	6.7 ± 7.4	6.8 ±7.8	6.6 ± 7.0	ns
BMI (kg/m²)	25.3 ± 3.1	25.1 ±2.5	25.6 ± 3.6	ns
Fasting glucose (mmol/L)	8.05 ± 2.35	8.41 ±2.61	7.65 ± 1.96	0.026
HbA_1c (%)	7.8 ± 1.7	7.8 ±1.7	7.8 ± 1.7	ns
Total cholesterol (mmol/L)	4.99 ± 0.84	4.80 ±0.83	5.20 ± 0.81	0.001
Triglyceride (mmol/L)	1.71 ± 1.14	1.70 ±1.30	1.73 ± 0.97	ns
HDL-C (mmol/L)	1.26 ± 0.27	1.22 ±0.28	1.30 ± 0.24	0.028
LDL-C (mmol/L)	3.14 ± 0.78	3.06 ±0.80	3.24 ± 0.75	ns
sd-LDL-C (mmol/L)	0.79 ± 0.43	0.81 ±0.45	0.77 ± 0.40	ns
Percentage of sd-LDL-C (%)	25.6 ± 14.0	26.9 ±14.5	24.1 ± 13.3	ns
lb-LDL-C (mmol/L)	2.35 ± 0.72	2.25 ±0.73	2.47 ± 0.70	0.037
Percentage of lb-LDL-C (%)	74.4 ± 14.0	73.1 ±14.5	75.9 ± 13.3	ns
Insulin (pmol/L)	59.5 ± 37.3	54.2 ±31.7	65.3 ± 42.2	ns
HOMA_IR	2.93 ± 2.15	2.79 ±2.07	3.09 ± 2.24	ns
Leptin (ng/mL)	8.16 ± 5.73	4.82 ±3.02	11.90 ± 5.75	< 0.001

Data are expressed as means ±SD.

BMI, body mass index; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; sd-LDL-C, small dense low density lipoprotein cholesterol; lb-LDL-C, large buoyant low density lipoprotein cholesterol; ns, not significant.

Table 2.

Clinical characteristics according to the tertile of leptin in male

Tertile of leptin	1	2	3
N	33	34	34
Range of leptin (ng/mL)	1.12 ~ 2.85	2.86 ~ 5.37	5.38 ~ 17.68
Age (years)	54.5 ± 10.0	54.9 ± 14.1	56.4 ± 12.0
Duration of diabetes (years)	6.1 ± 8.1	6.0 ± 6.9	8.3 ± 8.3
BMI (kg/m²)	23.4 ± 1.9	25.1 ± 2.0^*	26.7 ± 2.5^*†
Fasting glucose (mmol/L)	7.53 ± 2.13	8.87 ± 2.93	8.80 ± 2.56
HbA_1c (%)	7.5 ± 1.7	8.1 ± 2.0	7.9 ± 1.2
Total cholesterol (mmol/L)	4.64 ± 0.88	4.73 ± 0.91	5.03 ± 0.65
Triglyceride (mmol/L)	1.25 ± 1.33	1.82 ± 1.41^*	2.01 ± 0.97^*
HDL-C (mmol/L)	1.33 ± 0.33	1.14 ± 0.24	1.19 ± 0.24
LDL-C (mmol/L)	2.90 ± 0.80	3.01 ± 0.91	3.26 ± 0.66
sd-LDL-C (mmol/L)	0.67 ± 0.39	0.78 ± 0.39	0.98 ± 0.51^*
Percentage of sd-LDL-C (%)	24.1 ± 15.9	26.0 ± 12.4	30.3 ± 14.8
lb-LDL-C (mmol/L)	2.23 ± 0.81	2.23 ± 0.73	2.28 ± 0.69
Percentage of lb-LDL-C (%)	75.9 ± 15.9	74.0 ± 12.4	69.7 ± 14.8
Insulin (pmol/L)	37.1 ± 24.1	50.5 ± 25.0^*	74.5 ± 33.5^*†
HOMA_IR	1.69 ± 1.15	2.58 ± 1.18^*	4.06 ± 2.70^*†

Data are expressed as means ± SD.

^* P < 0.05 vs. tertile 1.

^† P < 0.05 vs. tertile 2.

Table 3.

Clinical characteristics according to the tertile of leptin in female

Tertile of leptin	1	2	3
N	29	31	30
Range of leptin (ng/mL)	4.19 ~ 8.52	8.90 ~ 12.86	13.13 ~ 37.52
Age (years)	56.7 ± 9.9	59.5 ± 9.2	62.0 ± 9.4
Duration of diabetes (years)	5.4 ± 5.9	5.8 ± 6.4	8.4 ± 8.3
BMI (kg/m²)	22.9 ± 2.1	25.7 ± 3.0^*	28.1 ± 3.6^*†
Fasting glucose (mmol/L)	7.30 ± 2.20	8.15 ± 1.89	7.52 ± 1.74
HbA_1c (%)	7.3 ± 1.6	7.9 ± 1.8	8.2 ± 1.5
Total cholesterol (mmol/L)	4.82 ± 0.69	5.43 ± 0.76^*	5.34 ± 0.86^*
Triglyceride (mmol/L)	1.53 ± 1.05	1.78 ± 0.84	1.88 ± 1.01
HDL-C (mmol/L)	1.33 ± 0.28	1.32 ± 0.23	1.26 ± 0.22
LDL-C (mmol/L)	2.98 ± 0.72	3.43 ± 0.74	3.29 ± 0.73
sd-LDL-C (mmol/L)	0.59 ± 0.33	0.88 ± 0.43^*	0.84 ± 0.39^*
Percentage of sd-LDL-C (%)	19.7 ± 11.1	27.0 ± 16.4	25.6 ± 10.7
lb-LDL-C (mmol/L)	2.40 ± 0.62	2.55 ± 0.80	2.44 ± 0.66
Percentage of lb-LDL-C (%)	80.3 ± 11.1	73.0 ± 16.4	74.4 ± 10.7
Insulin (pmol/L)	51.5 ± 44.0	66.5 ± 41.0^*	78.3 ± 38.4^*
HOMA_IR	2.42 ± 2.36	3.11 ± 1.93^*	3.77 ± 2.27^*

Data are expressed as means ± SD.

^* P < 0.05 vs. tertile 1.

^† P < 0.05 vs. tertile 2.

Table 4.

Comparison of clinical characteristics of patients between with history of cardiovascular disease and without cardiovascular disease

	CVD (-)	CVD (+)	P value
N	175	16
Age	56.8 ± 11.1	62.6 ± 9.9	< 0.05
Female (%)	47%	44%	0.781
Duration of diabetes (years)	6.4 ± 7.5	9.4 ± 5.7	0.25
BMI (kg/m²)	25.2 ± 3.0	26.8 ± 3.3	< 0.05
Fasting glucose (mmol/L)	7.95 ± 5.11	9.22 ± 2.27	< 0.05
HbA_1c (%)	7.8 ± 1.7	8.2 ± 1.5	0.329
Total cholesterol (mmol/L)	4.99 ± 0.83	5.11 ± 0.80	0.581
Triglyceride (mmol/L)	1.72 ± 0.83	1.80 ± 0.80	0.435
HDL-C (mmol/L)	1.27 ± 0.27	1.15 ± 0.17	0.096
LDL-C (mmol/L)	3.14 ± 0.76	3.21 ± 0.82	0.734
sd-LDL-C (mmol/L)	0.79 ± 0.43	0.92 ± 0.37	0.222
Percentage of sd-LDL-C (%)	25.3 ± 13.9	30.4 ± 13.9	0.164
lb-LDL-C (mmol/L)	2.36 ± 0.71	2.29 ± 0.73	0.716
Percentage of lb-LDL-C (%)	74.7 ± 13.9	69.6 ± 13.9	0.164
Insulin (pmol/L)	58.6 ± 37.8	71.7 ± 31.5	0.063
HOMA_IR	2.83 ± 2.14	4.14 ± 2.04	< 0.01
Leptin (ng/mL)	8.22 ± 5.85	7.85 ± 4.55	0.803

Data are expressed as means ± SD.

CVD, cardiovascular disease; BMI, body mass index; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; sd-LDL-C, small dense low density lipoprotein cholesterol; lb-LDL-C, large buoyant low density lipoprotein cholesterol.

Table 5.

Partial pearson’s correlation with leptin (log) and other parameters after adjustment of age, sex and BMI

	Correlation coefficiency (γ)	P value
sd-LDL-C	0.240	0.001
Percentage of sd-LDL-C	0.133	0.081
HbA_1c	0.096	ns
Total cholesterol	0.219	0.004
Triglyceride (log)	0.308	< 0.001
HDL-C	-0.034	ns
LDL-C	0.150	0.049
Insulin (log)	0.387	< 0.001
HOMA_IR (log)	0.415	< 0.001

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