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المستخلص
Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of differentorgans, especially the eyes, kidneys, nerves, heart, and blood vessels (American Diabetes Association, 2010).Apolipoprotein E (ApoE) is a 34.2 kDa glycosylated protein with 299 amino acid residues. The apoE gene is located on chromosome 19q13.2, consisting of four exons and three introns and spanning 3597 nucleotides. There are three isoforms in human (apoE2, apoE3, and apoE4) due to different amino acid residues at positions 112 and 158, among which apoE3, with a cysteine residue at position 112 and an arginine residue at position 158, is the most common (Zhang et al., 2010 Cardiovascular diseases are significantly increased in patients with metabolic syndrome and type 2 diabetes. In particular, coronary artery disease causes much of the serious morbidity and mortality in patients with diabetes, who have a 2- to 4-fold increase in the risk of CAD. In one population-based study, the 7-year incidence of first myocardial infarction or death was 20% for diabetic patients, but only 3.5% for nondiabetic patients (Zhang et al., 2009). This study aimed at detection the role of apolipoprotein E polymorphism as a risk factor of coronary artery disease in type 2 diabetic patients. Summary Summary This study was carried out at Menoufiya University Hospital, where samples were collected from the inpatients of Catheterization Unit in Menoufiya university hospital in the duration from October 2008 to February 2011 The study involved 70 diabetic patients (47 males, 23 females), their ages ranged between 38 - 62 years. The patients group was divided into 2 groups: group I included 35 diabetic patients with coronary artery diseases (24 males, 11 females), their ages ranged between 42-62 years and group II included 35 diabetic patients without coronary artery diseases (23 males, 12 females), their age ranged between 38-62 years. In addition 30 apparently healthy age and gender matched subjects were involved in this study as a control group (21 males, 9 females).All individuals were subjected to through history taking, full clinical examination, and Laboratory investigations. These included the following: Fasting & 2h. Postprandial blood glucose level, lipid profile, and determination of apo-E genotypes by PCR–RFLP.The results of this study revealed that:♦ The studied groups were well matched as regard ages, gender♦ The level of fasting blood glucose and 2h postprandial were significantly higher in patients groups (diabetic patients with coronary artery diseases and diabetic patients without coronary artery diseases) when compared with controls.♦ The level of total cholesterol, triglycerides, LDL-c and LDL-c/ HDLc ratio were significantly higher in patients groups (diabetic patients with coronary artery diseases and diabetic patients without coronary artery diseases) when compared with controls. While the level of HDL-c was significantly lower in patient groups when compared with controls. Summary ♦ The blood pressure was significantly higher in diabetic patients groups when compared with controls.♦ The smoking was significantly associated with diabetic patients when compared with controls.♦ The prevalence of apolipoprotein E genotypes and phenotypes among the study populations showed that apo E3 (E3/ E3) is the commonest one, followed by apo E2 (E2/ E2 and E2/ E3) and lastly apo E4 (E3/ E4).♦ The prevalence of apolipoprotein E alleles among the study populations showed that apo E3 allele is the commonest one, followed by apo E2 allele and lastly apo E4 allele.♦ The E4 and E2 allele frequencies were more significantly higher among diabetic patients with coronary artery diseases than among the controls. However E3 allele frequency was more prominent among controls than among diabetic patients with coronary artery diseases.♦ There was no significant difference between E3, E4 and E2 allele frequencies between diabetic patients without coronary artery diseases and the controls. The E3 allele was represented more in diabetic patients without coronary artery diseases in comparison to controls.♦ Significant association had been confirmed between higher level of total cholesterol, LDL-c and triglycerides and E4 allele when compared with E3 allele regarding diabetic patients with coronary artery diseases and controls. In addition the lower level of HDL-c was significantly associated with E4 allele when compare with E3 allele regarding diabetic patients with coronary artery diseases. The E4 allele was most prominently observed in genotype E3/ E4. Patients with genotype E3/ E3 Summary tended to have normal total cholesterol and HDL- cholesterol levels with low to normal LDL-cholesterol level.♦ Also, significant association had been confirmed between higher level of total cholesterol, LDL-c and triglycerides and E4 allele when compared with E3 allele regarding diabetic patients without coronary artery diseases and controls. In addition the lower level of HDL-c was significantly associated with E4 allele when compared with E3 allele regarding diabetic patients without coronary artery diseases.♦ There was no significant association had been confirmed between the level of total cholesterol, LDL-c, HDL-c and triglycerides and E4 allele when compared with E3 allele regarding control group.♦ Also, there was no significant association had been confirmed between the level of total cholesterol, LDL-c, HDL-c and triglycerides and E2 allele when compared with E3 allele regarding all diabetic patients and control group.♦ The multiple logistic regression analysis between apo E allele frequencies in diabetic patients with coronary artery disease revealed that the apoE2 allele and apoE4 allele increases risk of diabetic patients with coronary artery diseases when compared with control.♦ Finally, by multiple logistic regression analysis between apo E allele frequencies in diabetic patients without coronary artery disease, it was found that the apoE2 allele and apoE4 allele has no risk for diabetic patients without coronary artery diseases when compared with control.