Comparing Atherogenic Ratios Using Paraoxonase 1 and HDL-C in Diagnosis of Severity of Coronary Artery Disease in Type 2 Diabetes Patients with Nephropathy

Background and purpose: Recent studies suggest that HDL-C may not serve as a useful biomarker in the diagnosis of coronary artery disease (CAD). The present study aimed to improve the prediction of CAD in type 2 diabetes (T2D) patients with nephropathy by substituting the activity of paraoxonase 1 (PON1) for HDL-C. Materials and methods: This study examined 48 T2D patients who underwent coronary angiographic examination. The subjects were divided into two groups: non-CAD and CAD. For measuring PON1 activity, the initial rate of substrate hydrolysis (phenylacetate) was spectrophotometrically assayed at 270 nm. Receiver operating characteristic (ROC) analyses were performed to compare the predictive performance of the study biomarkers. Results: The area under the ROC curve showed increases in the diagnostic performance of the study atherogenic ratios by replacing HDL-C with the PON1 in T2D patients with nephropathy. LDL-C/PON1 (AUC=0.72, P=0.048) and log (TG/PON1) (AUC=0.81, P=0.005) had higher predictive powers compared with LDL-C/HDL-C (AUC=0.56, P=0.276) and log (TG/HDL-C) (AUC=0.67, p=0.038) for CAD risk assessment. Conclusion: The ratios of LDL-C/PON1 and log (TG/PON1) improve the prediction of CAD in T2D patients with nephropathy. Our findings support efforts to practically use HDL function instead of HDL-C levels for CAD diagnosis.