| OBJECTIVES: Type 2 diabetes mellitus is associated with a considerably enhanced risk of cardiovascular disease. Several epidemiological studies have demonstrated an association between 2-h glucose values following a 75-g glucose load and (cardiovascular) mortality. However, in diabetic subjects, glycaemic indices, such as glycated haemoglobin (HbA1c) and fasting blood glucose levels, are not strongly associated with cardiovascular disease. Possibly, postprandial glucose is a risk marker, rather than a risk factor. Diabetes is also associated with elevated postprandial levels of triglyceride-rich lipoproteins. Recent data indicate that postprandial triglyceridaemia is associated with carotid artery intima-media thickness (IMT) and impaired brachial artery flow-mediated vasodilatation. The hypothesis underlying the study is that postprandial lipoprotein responses, and in particular the triglyceride-rich lipoproteins, are more closely associated with cardiovascular disease than postprandial glycaemia in diabetic and in non-diabetic subjects. METHODS: A cross-sectional study in 100 female patients with diabetes and 100 normoglycaemic women. Glucose and (apo)lipoprotein levels, and especially remnant-like particles will be measured before and following a standardized breakfast and lunch: these meals will be composed once of high fat and once of high carbohydrate nutrients. The carotid artery IMT, the ankle/brachial pressure indices, an ECG, measurement of endothelium-dependent vasodilatation (flow-mediated vasodilatation, FMD), 24-h blood pressure, anthropometry, food intake and physical activity will be assessed in all subjects. The study will start in the Diabetes Research Centre in Hoorn at the beginning of 2003. |
