diabetes mellitus ( dm ) refers to a group of common metabolic disorders that share a phenotype of hyperglycemia . currently , the prevalence of diabetes worldwide is estimated to be around 415 million ( 8.8% of the whole population ) and is predicted to reach 642 million by 2040 . india has the second highest number of diabetics with estimated prevalence of 69.3 million , which is expected to reach 123.5 million by 2040 . incidence of sudden cardiac death is on the rise , especially in the urban regions of india , which may largely be attributed to the increase in prevalence of coronary artery disease ( cad ) , diabetes , and hypertension . indeed , type 2 dm ( type 2 dm ) is associated with a 2 - 4 fold increase in the risk of developing cad . however , such an increased risk can not be explained by hyperglycemia alone , as other cardiovascular risk factors such as hypertension and dyslipidemia also play a major role . moreover , it is observed that the prevalence of other cardiovascular risk factors such as smoking , sedentary lifestyle , and obesity are higher among diabetic compared to nondiabetic patients . the role of some risk factor such as serum uric acid levels in developing cvd is still controversial . framingham study has suggested that hyperuricemia is only a bystander in cvd and its association with the disease is indirectly influenced by confounding factors such as obesity , dyslipidemia , hypertension , use of diuretics , and insulin resistance . on the contrary , several other studies have identified serum uric acid levels as an independent predictor of cvd in various population groups . such contrasting reports make it difficult to delineate the specific role of hyperuricemia in cvd , thus limiting its clinical application . nevertheless , understanding the association between hyperuricemia and cvd , especially in patients with type 2 dm in the absence of other confounding factors may be a worthy consideration . hence , we evaluated the risk factors of cvd including serum uric acid levels among subjects with type 2 dm . a prospective case - control study was designed at the vydehi institute of medical sciences and research centre , bengaluru , india , after obtaining approval from the institutional ethics review board . about fifty type 2 dm patient 's aged > 40 years and fifty age- and sex - matched nondiabetic controls were included in the study after obtaining written informed consent . pregnant and lactating mothers , patients with renal failure , renal transplant , hepatic and metabolic disorders , and gout were excluded from the study . patients on long - term thiazide diuretics , antitubercular drugs , glucocorticoids , chemotherapy , and regularly consuming alcohol were also excluded . the clinical data obtained included the following : body weight , height , waist - to - hip ratio ( whr ) , systolic and diastolic blood pressure , duration of diabetes , history of smoking , family history of cvd , and the presence of ischemic heart disease . laboratory investigations included the following : fasting and postprandial plasma glucose levels , blood urea , serum creatinine , and serum uric acid levels . fasting serum lipid parameters were noted from the tests done during statin - nave period . continuous variables between two groups were analyzed using unpaired t - test and categorical variables by chi - square test or by fisher 's exact test ( when sample size was small ) . pearson correlation coefficient ( r ) was used to study the correlation between serum uric acid and other variables . continuous variables between two groups were analyzed using unpaired t - test and categorical variables by chi - square test or by fisher 's exact test ( when sample size was small ) . pearson correlation coefficient ( r ) was used to study the correlation between serum uric acid and other variables . body mass index ( bmi ) , whr , serum uric acid , serum total cholesterol , low - density lipoprotein ( ldl ) cholesterol , triglycerides , very ldl cholesterol levels were significantly higher , whereas serum high - density lipoprotein ( hdl ) cholesterol levels were significantly lower among diabetic patients . the glycemic parameters such as fasting plasma glucose and postprandial glucose were significantly higher among diabetic subjects . comparison of the baseline characteristics of the diabetics with controls a 26% prevalence rate of cad was observed among diabetic patients . patients with cad had significantly higher incidence of hypertension , family history of cad and higher duration of diabetes and higher serum uric acid , total cholesterol , ldl cholesterol levels , and lower serum hdl cholesterol levels [ table 2 ] . on univariate analysis , serum ldl cholesterol ( odds ratio [ or ] : 29.67 , p < 0.001 ) , serum uric acid ( or : 25.65 , p < 0.001 ) , low hdl cholesterol ( or : 21.12 , p < 0.001 ) , hypertension ( or : 17.06 , p < 0.001 ) , family history of cvd ( or : 9.43 , p = 0.002 ) , and duration of diabetes ( or : 4.65 , p = 0.03 ) were observed as possible predictors of cvd among diabetic patients . on multivariate regression , only ldl cholesterol ( or : 1.51 , p = 0.002 ) and serum uric acid ( or : 1.21 , p = 0.01 ) were the independent predictors of cad among diabetic patients . serum uric acid levels significantly and positively correlated with duration of diabetes ( r = 0.38 , p = 0.006 ) , bmi ( r = 0.35 , p = 0.01 ) , triglycerides ( r = 0.356 , p = 0.01 ) , ldl cholesterol ( r = 0.38 , p = 0.007 ) , hdl cholesterol ( r = 0.514 , p < 0.001 ) , and hypertension ( r = 0.524 , p < 0.001 ) . the bmi cut - off for diabetes risk in asian - indians is less when compared to that of caucasians . in a multicenter randomized clinical trial , an increased likelihood for the development of type 2 dm was observed among south asians with a bmi value of > 22 kg / m , whereas in urban indian population , a bmi of > 23 kg / m significantly increased the risk of diabetes . despite low rates of general obesity among indians , central obesity , measured as whr , this android pattern of body fat , typified by more upper body adiposity ( increased whr ) , was a greater risk factor for diabetes as compared to general obesity . high bmi ( bmi > 40 kg / m ) in diabetic women is also associated with increased risk of complications including cvd . surprisingly , in our study , bmi was not significantly associated with cvd , this may be due to lower bmi of our diabetic cohort than that of caucasian diabetic patients . in our study , diabetic patients had higher total cholesterol , triglycerides , ldl cholesterol , prevalence of hypertension and lower hdl cholesterol than nondiabetic patients , which is consistent with published reports . we also observed higher serum uric acid levels among diabetics than nondiabetics with significant positive correlation between serum uric acid levels and duration of diabetes . hyperglycemia is a well - known risk factor for hyperuricemia and also hyperuricemia is a risk factor for the development of diabetes . such counter influence leads to a vicious cycle , which may drive the development of co - morbidities such as cvd in general and cad in specific . indeed , in a study of 3,681 japanese adults , hyperuricemia significantly increased the risk of type 2 diabetes . serum ldl cholesterol , hypertension , and family history of cvd are the proven risk factors for cad among diabetics and reduction of ldl cholesterol and control of hypertension have proven to protect against cad . although low hdl cholesterol has been shown to be a risk factor for cvd , attempts to decrease cvd by increasing hdl cholesterol have not shown clinical benefits . however , in our study , hypertension , low hdl cholesterol , family history of cvd and smoking were not identified as independent predictors although they are proven cv risk factors . this could probably be due to small sample size of our study and warrants further evaluation . serum uric acid levels were observed as an independent predictor of cad among diabetics , thereby indicating the role of uric acid in promoting vascular inflammation . however , the role of serum uric acid as a risk factor for cvd is debatable . higher serum uric acid levels in patients with established cad is previously reported . however , it is difficult to delineate the role of uric acid in predicting cad due to its association with other cad risk factors including obesity , insulin resistance , hypertriglyceridemia , and hypercholesterolemia . each of these components of metabolic syndrome is demonstrated to be an independent risk factor for cvd and synergistically accelerate both nondiabetic atherosclerosis and the atheroscleropathy associated with type 2 dm . in the monica augsburg cohort involving 1044 males , a significant association between hyperuricemia and cardiovascular mortality was observed , which was independent of bmi , serum cholesterol concentration , hypertension , diuretic use , alcohol intake , and smoking habits . in the gothenburg prospective study evaluating 1462 women aged 38 - 60 years , a significant correlation was observed between serum uric acid concentration and total mortality during 12 years follow - up , which was independent of bmi , serum lipid concentrations , smoking habit , blood pressure , and age . in contrast , association of hyperuricemia with fatal and nonfatal cad was not observed in the british regional heart study ( 7688 men , aged 40 - 59 years ) after correcting for other risk factors , particularly serum cholesterol concentration . the coronary drug project research group evaluating 2789 men , aged 30 - 64 years , did not find any association between increased cardiovascular risk and hyperuricemia . association of hyperuricemia with bmi is reported in a recent study . in concurrence with previous reports , we observed significant positive correlation of serum uric acid with serum triglycerides , serum total cholesterol , ldl cholesterol , and negative correlation with hdl cholesterol levels . preclinical studies have demonstrated the development of hypertension by inducing hyperuricemia , which is associated with hyperreninemia and decreased nitric oxide synthesis in the juxtaglomerular apparatus . nevertheless , our study does have some limitations such as small sample size , exclusion of other risk factors such as hyperhomocysteinemia , increased reactive oxygen species , and high sensitivity c - reactive protein . well - established cardiovascular risk factors such as total cholesterol , triglycerides , ldl cholesterol , and prevalence of hypertension were higher and hdl cholesterol was lower among diabetic patients . serum ldl cholesterol and hyperuricemia were identified as independent predictors of cad among asian indian subjects with type 2 dm in this small cohort of prospective study .
aim : we aimed to identify the predictors of coronary artery disease ( cad ) in patients with type 2 diabetes mellitus ( type 2 dm).methods : about fifty asian indian patients with type 2 dm patients aged > 40 years and fifty sex- and age - matched nondiabetic controls were enrolled for this study . following complete medical history and baseline clinical data , 
 laboratory investigations were performed to assess fasting and postprandial plasma glucose levels , lipid profile , blood urea , serum creatinine , and serum uric acid levels.results:body mass index ( bmi ) , waist - to - hip ratio , serum uric acid , serum total cholesterol , low - density lipoprotein ( ldl ) cholesterol , triglycerides , very ldl cholesterol were significantly higher among diabetic patients compared to controls . 
 on univariate analysis , serum ldl cholesterol ( odds ratio [ or ] : 29.67 , p < 0.001 ) , serum uric acid ( or : 25.65 , p < 0.001 ) , low high - density lipoprotein ( hdl ) cholesterol ( or : 21.12 , p < 0.001 ) , hypertension ( or : 17.06 , p < 0.001 ) , family history of cardiovascular disease ( cvd ) ( or : 9.43 , p = 0.002 ) , and duration of diabetes ( or : 4.65 , p = 0.03 ) were identified as predictors of cvd among diabetic patients . on multivariate regression , 
 only ldl cholesterol ( or : 1.51 , p = 0.002 ) and serum uric acid ( or : 1.21 , p = 0.01 ) were the independent predictors of cad among diabetic patients . 
 significant positive correlation of serum uric acid with duration of diabetes ( r = 0.38 , p = 0.006 ) , bmi ( r = 0.35 , p = 0.01 ) , triglycerides ( r = 0.356 , p = 0.01 ) , ldl cholesterol ( r = 0.38 , p = 0.007 ) , hdl cholesterol ( r = 0.514 , p < 0.001 ) , and hypertension ( r = 0.524 , p < 0.001 ) was observed.conclusion:serum ldl cholesterol and hyperuricemia may serve as independent predictors of cad among asian indian subjects with type 2 dm .