الفهرس 
Diabetes in Older AdultsOnly 14 pages are availabe for public view
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Abstract
Abstract: Background Peripheral arterial disease (PAD) in the lower extremities is a marker of widespread vascular disease particularly in the coronary and cerebral circulation and is the leading cause of mortality especially in diabetic population. Coronary heart diseases (CHD) may be related to genetic mutations in the production of apolipoprotein E (ApoE), partly via alterations to the metabolism of CHD-related lipids as LDL and TG, in addition to other unexplained and interacting factors. In this work, we studied the association of apoE4 genotypes with CHD and PAD in a cohort of elderly diabetic patients compared to controls. Objectives: The aim of the present study is to assess the genetic frequency of ApoE4 and the prevalence of PAD among a target group of elderly diabetic patients with and without complications, with respect to the presence of established CVD and/or major coronary risk factors, compared to non-diabetic elderly controls. Methods: Our study was a case-control study, conducted on 90 elderly subjects categorized into 30 patients with type2 diabetes mellitus (T2DM) with atherosclerotic cardiovascular (CV) complications, 30 patients with type T2DM without atherosclerotic CV complications and 30 normal healthy elderly subjects without DM or evidence of atherosclerotic CV disease. Lipid profile was assessed for each subject in the study, ankle-brachial index (ABI) and arterial duplex ultrasound (DUS) were performed to detect those with poorly compressible peripheral arteries (PCA) in this older age group and to confirm or exclude the presence of PAD among the study subjects. ApoE genotyping was done by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) to identify the genetic characteristics of the study population with the subsequent study of the variables among ApoE-ɛ4 allele carriers and non-carriers. Results: The frequencies of E3/E3and E3/E4 genotypes as well as the prevalence of PAD and PCA, were significantly increased among the diabetic patients with CVD compared to those with T2DM without CVD and controls. Moreover, it was found that, among the diabetic group with CHD and PAD, the frequency of the ɛ4 allele carrier state was significantly higher than those without this allele. However, this significant difference was not found among those diabetic patients with CHD and PCA. Conclusions: The Apo ε4 allele may be associated with clustering of cardiovascular complications in T2DM in the form of its association with CHD in elderly diabetic patients with PAD. Therefore, further genetic studies are needed to add information beyond the traditional cardiovascular risk factors in T2DM, and to identify risk genotypes that might be involved in the occurrence of diabetic complications for early prediction and identification of at risk patients.