dr zainab thesis for dr lili

8/19/2019 Dr Zainab Thesis for Dr Lili

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LDL-C TARGET ACHIEVEMENT, FACTORSASSOCIATED WITH NONACHIEVEMENTOF LDL-C TARGET AND ADHERENCE TOSTATIN THERAPY AMONG PATIENTS WITHTYPE 2 DIABETES MELLITUS

A thesis su!itte" #$% the De&%ee $# M'ste% $# F'!i() Me"i*i+e

CANDIDATE NO: T3006

NOVEMBER 2.


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Table of ContentsLIST OF TABLES//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////0

LIST OF FIGURES//////////////////////////////////////////////////////////////////////////////////////////////////////////////////0i

ABBREVIATIONS//////////////////////////////////////////////////////////////////////////////////////////////////////////////////0ii

ABSTRACT//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////i1

English Version/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////i1

Malay Version///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////1i

CHAPTER ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

INTRODUCTION//////////////////////////////////////////////////////////////////////////////////////////////////////////////////

/ D)s(ii"'e!i' '+" C'%"i$0's*u('% "ise'se/////////////////////////////////////////////////////////////////////

/2 D)s(ii"'e!i' '+" Di'etis Me((itus///////////////////////////////////////////////////////////////////////////////2

/3 L$4 De+sit) Li$%$tei+ Ch$(este%$(//////////////////////////////////////////////////////////////////////////////3

5usti#i*'ti$+ $# %ese'%*h//////////////////////////////////////////////////////////////////////////////////////////////////////////6

CHAPTER 2///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////7

LITERATURE REVIEW///////////////////////////////////////////////////////////////////////////////////////////////////////7

2/ LDL-C t'%&et i+ D)s(ii"'e!i' '+" T)e 2 Di'etes Me((itus////////////////////////////////////7

2/2 St'ti+ the%') i+ ")s(ii"'e!i'////////////////////////////////////////////////////////////////////////////////////8

2/2 LDL-C A*hie0e!e+t '+" its 'ss$*i'te" #'*t$%s///////////////////////////////////////////////////////////9

2/3 Me"i*'ti$+ '"he%e+*e/////////////////////////////////////////////////////////////////////////////////////////////////

2/. LDL '*hie0e!e+t '+" '"he%e+*e///////////////////////////////////////////////////////////////////////////////.

CHAPTER 3/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////6

OB5ECTIVES//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////6

3/ Ge+e%'( O:e*ti0es/////////////////////////////////////////////////////////////////////////////////////////////////////////6

3/2 Se*i#i* $:e*ti0es/////////////////////////////////////////////////////////////////////////////////////////////////////////6

3/3 RESEARCH HYPOTHESIS/////////////////////////////////////////////////////////////////////////////////////6

3/. Oe%'ti$+'( "e#i+iti$+////////////////////////////////////////////////////////////////////////////////////////////////7

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CHAPTER ./////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////8

METHODOLOGY///////////////////////////////////////////////////////////////////////////////////////////////////////////////8

./ Stu") "esi&+///////////////////////////////////////////////////////////////////////////////////////////////////////////////////8

./2 Stu") '%e'///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////8

./3 P$u('ti$+ '+" s'!(e///////////////////////////////////////////////////////////////////////////////////////////////////8

./3/ Re#e%e+*e $u('ti$+//////////////////////////////////////////////////////////////////////////////////////////////8

./3/2 S$u%*e $u('ti$+////////////////////////////////////////////////////////////////////////////////////////////////////;

./3/3 Stu") $u('ti$+/////////////////////////////////////////////////////////////////////////////////////////////////////////;

./3/. I+*(usi$+ *%ite%i'/////////////////////////////////////////////////////////////////////////////////////////////////////;

./3/6 E1*(usi$+ C%ite%i'///////////////////////////////////////////////////////////////////////////////////////////////////;

./3/7 S'!(i+& !eth$"///////////////////////////////////////////////////////////////////////////////////////////////////9

./3/8 S'!(e si


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CHAPTER 7/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////.

DISCUSSION//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////.

7/ P%$$%ti$+ $# LDL-C &$'( '*hie0e%s '+" +$+'*hie0e%s '!$+& 'tie+ts 4ith T)e 2

Di'etes Me((itus/////////////////////////////////////////////////////////////////////////////////////////////////////////////////.7/2 Pe%*e+t'&e $# '"he%e+*e t$ st'ti+ the%') '+" %e('ti$+shi 4ith//////////////////////////////.3

LDL-C t'%&et '*hie0e!e+t///////////////////////////////////////////////////////////////////////////////////////////////////.3

7/3 The 'ss$*i'te" #'*t$%s t$ +$+'*hie0e!e+t $# LDL-C t'%&et/////////////////////////////////////.7

7/3/ S$*i$"e!$&%'hi* #'*t$%s//////////////////////////////////////////////////////////////////////////////////.7

7/3/2 C(i+i*'( #'*t$%s///////////////////////////////////////////////////////////////////////////////////////////////////.8

CHAPTER 8/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////6

CONCLUSIONS//////////////////////////////////////////////////////////////////////////////////////////////////////////////////6

CHAPTER ;/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////62

LIMITATIONS OF THE STUDY////////////////////////////////////////////////////////////////////////////////////////62

RECOMMENDATIONS//////////////////////////////////////////////////////////////////////////////////////////////////////6.

REFERENCES/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////66

.


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LIST OF TABLES

T'(e ./= S'!(e si


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LIST OF FIGURES

Fi&u%e ./ F($4 *h'%t $# the stu")///////////////////////////////////////////////////////////////////////////////////////////2;

Fi&u%e ./2 C$+*etu'( #%'!e4$%> $# stu")//////////////////////////////////////////////////////////////////////////////29

Fi&u%e6/The %$$%ti$+ $# LDL *h$(este%$( '*hie0e!e+t '!$+& 'tie+ts 4ith T)e 2

Di'etes Me((itus//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////3.

Fi&u%e 6/2The e%*e+t'&e $# 'tie+ts 4ith T)e 2 Di'etes Me((itus i+ '"he%e+*e t$ st'ti+

the%')//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////36

7


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LIST OF APPENDIXES

Ae+"i1 I Ethi* '%$0'( #%$! u+i0e%sit) Rese'%*h Ethi*s C$!!ittee 72Ae+"i1 II A%$0'( #%$! H$sit'( 73

Ae+"i1 III C$+se+t #$%! 7.

Ae+"i1 IV C'se Re$%t F$%! 79

Ae+"i1 V ?uesti$++'i%e 82

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ABSTRACT

English Version

Titt(e= L$4 De+sit) Li$%$tei+ Ch$(este%$( t'%&et '*hie0e!e+t, #'*t$%s 'ss$*i'te" 4ith

+$+'*hie0e%s '+" '"he%e+*e t$ st'ti+ the%') '!$+& 'tie+ts 4ith T)e 2 Di'etes Me((itus/

I+t%$"u*ti$+= G($'((), *'%"i$0's*u('% "ise'se is the (e'"i+& *'use $# !$%t'(it) '+" !$%i"it)/

D)s(ii"'e!i' is ' %is> #'*t$% #$% *'%"i$0's*u('% "ise'se '+" T)e 2 Di'etes Me((itus is '

*'%"i$0's*u('% %is> eui0'(e+t/ L$4 "e+sit) (i$%$tei+ *h$(este%$( LDL-C is the %i!'%)

t'%&et i+ the !'+'&e!e+t $# ")s(ii"'e!i' '+" '*hie0e!e+t $# LDL-C t'%&et '**$%"i+& t$

N'ti$+'( Ch$(este%$( E"u*'ti$+ P%$&%'!!e NCEP-ATP III is *%u*i'(/

St'ti+s '%e $te+ts "%u& t$ %e"u*e *h$(este%$( ese*i'(() the LDL-C, h$4e0e% the

e##e*ti0e+ess is (i!ite" ) the $$% '"he%e+*e/

Obj!"#$%: T$ "ete%!i+e %$$%ti$+ $# LDL-C t'%&et '*hie0e!e+t, #'*t$%s 'ss$*i'te" 4ith

+$+'*hie0e%s '+" the '"he%e+*e t$ st'ti+ the%') '!$+& 'tie+ts 4ith T)e 2 Di'etes

Me((itus/

M"&'(')'*+: A *%$ss se*ti$+'( stu") i+0$(0i+& 23. 'tie+ts '&e" ; )e'%s $(" '+" '$0e

4h$ h'" *$!$%i" T)e 2 Di'etes Me((itus '+" D)s(ii"'e!i'/ S)ste!'ti* R'+"$!

S'!(i+& 4ith %e('*e!e+t !eth$" 4's '(ie" t$ se(e*t '%ti*i'+ts 4h$ 'tte+"e" @R@,

HUSM #%$! 5'+u'%) 23 t$ M') 23/ B$th se(#-'"!i+iste%e" '+" i+te%0ie4e%e"

'"!i+iste%e" uesti$++'i%es 4e%e use" t$ $t'i+ the s$*i$ "e!$&%'hi* *h'%'*te%isti*s,

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*(i+i*'( *h'%'*te%isti*s '+" *$!(i'+*e uesti$++'i%e/ The "'t' 4's '+'()se" #$% "es*%iti0e

st'tisti* '+" !u(ti(e ($&isti* %e&%essi$+/

R%,)": The e%*e+t'&e $# LDL-C t'%&et '*hie0e!e+t 4's 38/7/ The e%*e+t'&e $# 'tie+ts

'"he%e" t$ st'ti+ the%') 4's 9;/3 '+" 2/6 $# 'tie+ts '"he%e" #u(()/ The%e 4's +$

si&+i#i*'+t %e('ti$+ et4ee+ LDL-C '*hie0e!e+t '+" '"he%e+*e/ S$*i$"e!$&%'hi*

"'t'su*h 's '&e, !'%it'( st'tus, &e+"e%, e"u*'ti$+ (e0e( '+" h$useh$(" i+*$!e '+" *(i+i*'(

"'t' su*h 's s!$>i+& st'tus, +u!e% $# %es*%ie" !e"i*'ti$+s, BMI, SBP, "u%'ti$+ $+

st'ti+ the%) '+" t)e $# st'ti+ t'>e+/ 4e%e +$t 'ss$*i'te" 4ith '*hie0e!e+t $# LDL-C t'%&et/

HA* is the $+() si&+i#i*'+t #'*t$% th't 'ss$*i'te" 4ith LDL-C t'%&et '*hie0e!e+t/

C'!),%#': A*hie0e!e+t $# ($4 "e+sit) (i$%$tei+ t'%&et '!$+& T)e 2 Di'etes Me((itus

'tie+ts 'tte+"e" @R@,HUSM 4's sti(( ($4/ M':$%it) 'tie+ts 4e%e '"he%e" t$ st'ti+ the%')

h$4e0e% the %e('ti$+ et4ee+ '"he%e+*e '+" LDL-C '*hie0e!e+t 4's +$t si&+i#i*'+t/ HA*

4's the $+() si&+i#i*'+t #'*t$% 'ss$*i'te" t$ LDL-C/


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Malay Version

T.j,/: Pe+*''i'+ s's'%'+ >$(este%$( (i$%$tei+ >etu!'t'+ %e+"'h "'+ #'>t$%-#'>t$% )'+&

!e!e+&'%uhi u>'+ e+*''i "'+ >e'tuh'+ te%h'"' u't >$(este%$( :e+is st'ti+ "i

>'('+&'+ es'>it @e+*i+& M'+is 5e+is 2/

P*.).: Di e%i+&>'t &($'(, e+)'>it >'%"i$0's>u('% !e%u'>'+ u+*' ut'!'

>e!'ti'+ "'+ !$%i"iti/ D)s(ii"'e!i' '"'('h #'>t$% %isi>$ '&i e+)'>it >'%"i$0's>u('% "'+

e+)'>it @e+*i+& M'+is :e+is 2 '"'('h %isi>$ >'%"i$0's>u('% )'+& set'%'/ @$(este%$(

(i$%$tei+ >etu!'t'+ %e+"'h '"'('h s's'%'+ ut'!' "'('! e+&u%us'+ ")s(ii"'e!i' "'+

e+*''i'++)' !e+&i>ut National Cholesterol Education Programme NCEP-ATP III '"'('h

e+ti+&/ Statin '"'('h u't '+ti>$(este%$( )'+& e%>es'+ u+tu> !e+&u%'+&>'+ >$(este%$(

te%ut'!'+)' >$(este%$( (i$%$tei+ >etu!'t'+ %e+"'h/ W'('u '&'i!'+'u+

>ee%>es'+'++)' '"'('h te%h'" "ise'>'+ $(eh >eti"'>'tuh'+ te%h'"' u't '+ti>$(este%$(/

Obj/"#: U+tu> !e+e+tu>'+ t'h' e+*''i'+ s's'%'+ >$(ete%$( (i$%$tei+ >etu!'t'+

%e+"'h, #'>t$%-#'>t$% )'+& !e!e+&'%uhi u>'+ e+*''i "'+ e%'tus >'"'% e!'tuh'+

te%h'"' u't >$(este%$( :e+is st'ti+/

M"'(')'*#: I+i '"'('h >':i'+ %e+t's )'+& !e(i't>'+ se%'!'i 32. es'>it e%u!u% ; t'hu+

"'+ >e 't's )'+& !e+&hi"'i e+)'>it @e+*i+& M'+is 5e+is 2/ Pe!i(ih'+ s'!e( se*'%'

Siste!'ti> R'!'+& te('h "i('>u>'+ u+tu> !e!i(ih ese%t' )'+& "'t'+& >e @R@, HUSM

"'%i 5'+u'%i 23 hi+&&' Mei 23/ B$%'+& s$'( se(i"i> te('h "i&u+'>'+ u+tu> !e+"''t>'+


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*i%i-*i%i s$si$ "e!$&%'#i, *i%i-*i%i >(i+i>'( "'+ s$'( se(i"i> e!'tuh'+ te%h'"' u't/ D't'

)'+& "ie%$(ehi te('h "i'+'(isis !e+&&u+'>'+ st'tisti> "es>%iti# "'+ %e&%esi ($&isti>

e%&'+"'/

K1,",%.: Pe%'tus'+ e+*''i'+ s's'%'+ >$(este%$( (i$%$tei+ >etu!'t'+ %e+"'h '"'('h

38/7/ Pe%'tus e!'tuh'+ >e'"' u't >$(este%$( :e+is st'ti+ '"'('h 9;/3 "'+ 2/6

es'>it te('h 'tuh see+uh+)'/ Ti'"' huu+&'+ )'+& si&+i#i>'+ '+t'%' t'h' e+*''i'+

>$(este%$( (i$%$tei+ >etu!'t'+ %e+"'h "'+ e!'tuh'+ te%h'"' u't >$(este%$( :e+is st'ti+/

D't' s$si$"e!$&%'#i see%ti u!u%, st'tus e%>'h4i+'+, :'+ti+', t'h' e+"i"i>'+ "'+

e+"''t'+ isi %u!'h "'+ "'t' >(i+i>'( see%ti st'tus !e%$>$>, :u!('h u't-u't'+ "i'!i(,

:isi! i+"e1 '"'+, te>'+'+ "'%'h sist$(i>, te!$h !e+&&u+'>'+ u't >$(este%$( :e+is st'ti+

"'+ :e+is st'ti+ )'+& "i'!i( ti"'> !e!u+)'i >'it'+ "e+&'+ t'h' e+*''i'+ s's'%'+

>$(este%$( (i$%$tei+ >etu!'t'+ %e+"'h/ HA* !e%u'>'+ s'tu-s'tu+)' #'>t$% )'+&

"ite!ui !e!u+)'i >'it'+ "e+&'+ t'h' e+*''i'+ (i$%$tei+ >etu!'t'+ %e+"'h/

K%#21,).: Pe+*''i'+ s's'%'+ >$(este%$( (i$%$tei+ >etu!'t'+ %e+"'h "i >'('+&'+

es'>it @e+*i+& M'+is 5e+is 2 "i @R@, HUSM '"'('h !'sih %e+"'h/ M':$%iti es'>it te('h

'tuh te%h'"' e+&'!i('+ u't >$(este%$( :e+is st'ti+/ HA* '"'('h s'tu-s'tu+)' #'>t$%

si&+i#i>'si )'+& !e!u+)'i e%>'it'+ "e+&'+ t'h' e+*''i'+ >$(este%$( (i$%$tei+

>etu!'t'+ %e+"'h/

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CHAPTER 1

INTRODUCTION

1.1 Dyslipiae!ia an Ca"io#as$%la" isease

C'%"i$0's*u('% "ise'se i+*(u"e *$%$+$%) he'%t "ise'se, *e%e%$0's*u('% "ise'se '+"

e%ihe%'( '%te%i'( "ise'se/ C$%$+$%) he'%t "ise'se is ' se*t%u! $# st'(e '+&i+', is*h'e!i*

he'%t "ise'se '+" !)$*'%"i'( i+#'%*ti$+/ A**$%"i+& t$ Mi+ist%) $# He'(th M'(')si',

*'%"i$0's*u('% "ise'se 4's the (e'"i+& *'use $# "e'th i+ 29 #$% $th !e+ '+" 4$!e+/ I+

2;, W$%(" He'(th O%&'+i #'*t$% '!$+& 'tie+ts 4ith ACS 4hi*h is %'te" 't 3 t$ 36 i+ 4hi*h

'tie+ts h'" hist$%) $# ")s(ii"'e!i' '+" i+ $0e%'((, 66/9 h'" '+$%!'( *h$(este%$( (e0e(/

D)s(ii"'e!i' is ' !':$% %is> #'*t$% #$% *'%"i$0's*u('% "ise'se2/ M'+)

ei"e!i$($&i* stu"ies h'0e sh$4+ th't ")s(ii"'e!i' is ' st%$+& %e"i*t$% $# the (i>e(ih$$"

th't '+ i+"i0i"u'( 4i(( "e0e($e" *'%"i$0's*u('% "ise'se/ Hi&h LDL '+" ($4 HDL h's ee+

"e!$+st%'te" 's %is> #'*t$%s 4hi*h '%e *'us'(() (i+>e" t$ *'%"i$0's*u('% "ise'se2/


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The St%$+& He'%t Stu") 'ssesse" the *'%"i$0's*u('% "ise'se %is> #'*t$%s i+ "i'eti*

i+"i0i"u'(s/ I+ this ('%&e *$h$%t stu"), it 4's #$u+" th't LDL *h$(este%$( 4's ' st%$+&

i+"ee+"e+t %e"i*t$% $# *$%$+$%) he'%t "ise'se '+" h' F'*t$% I+te%0e+ti$+ MRFIT, The P%$se*ti0e

C'%"i$0's*u('% Mu+ste% Stu") PROCAM '+" The F%'!i+&h'! He'%t Stu") h'" sh$4+

%e('ti$+shi et4ee+ Di'etes Me((itus '+" C$%$+$%) He'%t Dise'se !$%t'(it) 6-8/ N'ti$+'(

He'(th M$%i"it) Su%0e) i+ 2 #$u+" th't 36/ $# '"u(t '&e" ; )e'%s $(" '+" '$0e h'"2


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h)e%*h$(este%$('e!i' '+" su%isi+&() 27/7 4e%e %e0i$us() u+"i'&+$se" 4ith

h)e%*h$(este%$('e!i';/

D)s(ii"'e!i' '+" Di'etes Me((itus '%e !':$% %e"i*t$%s #$% *'%"i$0's*u('% "ise'se

's $th *(i+i*'( *$+"iti$+ h'0e '+ e##e*t t$4'%"s !'*%$0's*u('% "ise'se '+" #$%!'ti$+ $#

'%the%$&e+esis 9/ I+"i0i"u'( 4ith $th *(i+i*'( *$+"iti$+s '%e *$+si"e%e" t$ e 't ' hi&he%

%is> i+ "e0e($i+& *'%"i$0's*u('% "ise'se '+" t%e'ti+& t$ t'%&et is %e'(() i!$%t'+t t$ %e0e+t

#u%the% !$%i"it) '+" !$%t'(it) %esu(ti+& #%$! *'%"i$0's*u('% e0e+ts/

The !$%e %e*e+t() %e*$&+ise" #e'tu%es '%e s!'(( "e+se LDL-C '+" e1*essi0e

$st%'+"i'( (ie!i'/ S!'(( "e+se LDL-C '%ti*(es e'si() e+et%'te the 0's*u('%

e+"$the(iu! '+" &et "e$site" i+ the 4'((s $# the 0esse(s/ The e%*e+t'&e $# i+"i0i"u'(s

$ssessi+& s!'(( '+" "e+se LDL-C is hi&he% ) 't (e'st 2 #$("s i+ T2DM/ A!$+& 'tie+ts

4ith est'(ishe" *'%"i$0's*u('% "ise'se $% *'%"i$0's*u('% %is> eu'0'(e+t, h'%!'*$the%')

sh$u(" e&i+ 4ith '":u0'+t t$ the%'euti* (i#est()e !$"i#i*'ti$+ i+*(u"i+& e1e%*ise '+" "iete%)

i+te%0e+ti$+/ LDL C is the %i!'%) t'%&et #$% the%') '+" is "ee+"'+t u$+ '+ i+"i0i"u'(s

&($'( *'%"i$0's*u('% %is>/

1.( Lo) Density Lipop"otein C*oleste"ol

L$4 "e+sit) (i$%$tei+ LDL is $+e $# the #i0e !':$% &%$us $# (i$%$tei+s '+" the

*h$(este%$( 4hi*h is i+" t$ it is >+$4+ 's LDL *h$(este%$( $% is '(s$ 4e(( >+$4+ 's ' '"

*h$(este%$(/ The #i0e !':$% (i$%$tei+s i+*(u"i+& *h)($!i*%$+s, 0e%) ($4 "e+sit) (i$%$tei+

VLDL, i+te%!e"i'te "e+sit) (i$%$tei+ IDL, ($4 "e+sit) (i$%$tei+ '+" hi&h "e+sit)

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(i$%$tei+ 0'%ies i+ the te%! $# si $# *$%$+$%)

he'%t "ise'se eithe% i+ ' %e0i$us() he'(th) $u('ti$+ $% i+ 'tie+ts 4ith the %e('te" "ise'ses

su*h 's h)e%te+si$+ '+" "i'etes !e((itus/ N'ti$+'( Ch$(este%$( E"u*'ti$+ P%$&%'!!e

A"u(t T%e't!e+t P('+ I t$ III NCEP-ATP III h's est'(ishe" LDL *h$(este%$( 's ' %i!'%)

t'%&et $# the%'euti* i+te%'*ti$+ e*'use LDL *h$(este%$( (')s ' !':$% %$(e i+ i+iti'ti+& the

"e0e($!e+t $# 'the%$s*(e%$ti* ('ue/ Met' '+'()sis h'0e sh$4+ th't %e"u*i+& t$t'(

*h$(este%$( ) !!$(( si&+i#i*'+t() %e"u*es !$%t'(it) "ue t$ *$%$+$%) he'%t "ise'se2/

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,%"##!."#' ' 4%.4!&

This %ese'%*h is *$+"u*te" t$ "ete%!i+e %i!'%) (ii" t'%&et '*hie0e!e+t 4hi*h is ($4

"e+sit) (i$%$tei+ *h$(este%$( '+" the '"he%e+*e t$ st'ti+ the%') i+ 'tie+ts 4ith *$!$%i"

T)e 2 Di'etes Me((itus '+" D)s(ii"'e!i'/ N'ti$+'( Ch$(este%$( E"u*'ti$+ P%$&%'!!e

A"u(t T%e't!e+t P('+ I t$ III NCEP-ATP I -III h's est'(ishe" LDL *h$(este%$( 's ' %i!'%)

t'%&et $# the%'euti* i+te%'*ti$+ e*'use LDL *h$(este%$( (')s ' !':$% %$(e i+ i+iti'ti+& the

"e0e($!e+t $# 'the%$s*(e%$ti* ('ue/ It is *%u*i'( t$ '*hie0e the t'%&et $# LDL-C '**$%"i+&

t$ the %e*$!!e+"e" (e0e( 's it %e0e+t #u%the% %is> $# *'%"i$0's*u('% e0e+t/ This stu")

e0'(u'te" the *u%%e+t e%#$%!'+*e $# LDL-C '*hie0e!e+t i+ 'tie+ts 4ith T)e 2 Di'etes

Me((itus '+" %e#(e*te" the !'+'&e!e+t $# ")s(ii"'e!i' $# T)e 2 Di'etes Me((itus/ The

'"he%e+*e t$ (ii" ($4e%i+& the%') '%ti*u('%() st'ti+ &%$u 4hi*h 4's st'te" 's the !$st

$te+t '+ti(ii" i+ %e"u*i+& LDL-C (e0e( is '(s$ i!$%t'+t/ Bei+& '4'%e $# the #'*t$%s

'ss$*i'te" 4ith LDL-C '*hie0e!e+t, *'+ 'ssist us i+ %e*$&+isi+& 'tie+ts 4hi*h h'0e

te+"e+*) t$ e*$!e +$+-'*hie0e%s t$ LDL-C t'%&et/ It is '(s$ i!$%t'+t t$ i"e+ti#) u+"e%()i+&

s$*i$e*$+$!i* '+" (i#est)(e-%e('te" #'*t$%s i+ $%"e% t$ e&i+ '%$%i'te i+te%0e+ti$+s '+"

!'+'&e!e+t/

Ou% %i!'%) he'(th *'%e setti+& h's ' 0'st '%%') $# 'tie+ts *h'%'*the%isti* 4ith

"e!$&%'hi* "i##e%e+*es, 'tie+ts #%$! the %u%'( '%e's, se!iu%'+ '%e' 's 4e(( 's u%'+ '%e'

see>i+& t%e't!e+t i+ the s'!e #'*i(it)/ The i+#$%!'ti$+ $t'i+e" #%$! this stu") is use#u( #$%

the he'(th *'%e %$0i"e%s t$ e0'(u'te the '*hie0e!e+t $# *h$(este%$( (e0e( '+" !e"i*'ti$+

'"he%e+*e i+ thei% $4+ he'(th *'%e setti+& /

6


18/85

CHAPTER &

LITERATURE REVIEW

57 LDL-C ".4*" # D+%)#1#(.2#. .( T+1 5 D#.b"% M))#",%

I+ C(i+i*'( P%'*ti*e Gui"e(i+es $+ M'+'&e!e+t $# D)s(ii"'e!i' 2, the

$ti!'( %i!'%) t'%&et $# LDL-C 0'(ue is "ee+"e+t u$+ the 'tie+ts 'ssess!e+t $# &($'(

*'%"i$0's*u('% %is> #'*t$%s3/ NCEP-ATP III %e*$&+ise" th%ee %is> &%$u *'te&$%ies '+" the

LDL-C t'%&et is "ee+"e+t u$+ t$ the %is>s th't #'(( i+t$./ The th%ee %is> &%$us '%e ($4

%is> %is> #'*t$%, !$"e%'te %is>2 %is> #'*t$%s '+" hi&h %is> *'te&$%) CHD '+" CHD %is>

eui0'(e+ts, 4he%e i+ thei% LDL-C t'%&et '%e J./!!$((, J3/.!!$(( '+" J2/7!!$((/ The

t'%&et #$% 'tie+ts 4ith ")s(ii"'e!i' '+" T)e 2 Di'etes Me((itus i+ '**$%"'+*e t$ NCEP-

ATP III is J2/7!!$(( '+" this t'%&et is si!i('% t$ the A!e%i*'+ Di'etes Ass$*i'ti$+ADA

6/

C'+'"i'+ Di'etes Ass$*i'ti$+CDA st'te" i+ the 2; %'*ti*e &ui"e(i+e th't the

LDL-C t'%&et #$% T)e 2 Di'etes Me((itus is 2/!!$(( 4hi*h is !u*h ($4e% th'+ NCEP-

ATP III7/ Eu%$e'+ Athe%$s*(e%$tis S$*iet) Eu%$e'+ S$*iet) $# C'%"i$($&)EASESC

%e*$!!e+"e" the %i!'%) LDL-C t'%&et #$% 'tie+ts 4ith 0e%) hi&h %is> '+" hi&h %is>

'sJ/;!!$(( '+" J2/6!!$((8/ A!e%i*'+ C$((e&e $# C'%"i$($&) A!e%i*'+ He'%t

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*h$(este%$( t$ %e"u*e %is> $# Athe%$s*(e%$ti* C'%"i$0's*u('% Dise'seASCVD i+ '"u(tsK

7


19/85

%'isi+& !'+) *$+t%$0e%si'( issues;/ I+ the &ui"e(i+e, the%e is +$ t'%&et $# LDL-C '+"

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Di'etes Me((itus 4i(( e *('ssi#ie" u+"e% the &%$u th't +ee"s e t%e'te" 4ith hi&h i+te+sit)

st'ti+'t$0'st'ti+ .!& t$ ;!& $% R$su0'st'ti+ 2!&/

55 S"."# "&4.1+ # (+%)#1#(.2#.

St'ti+s '%e the !$st e##e*ti0e "%u& *('ss '+" is the t%e't!e+t $# *h$i*e i+ %e"u*i+& L$4

De+sit) Li$%$tei+ Ch$(este%$( '+" the) '(s$ h'0e '+ '""iti$+'( e##e*t $# '+ti'the%$s*(e%$thi*

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L$0'st'ti+ 4's the #i%st st'ti+ t$ e "e0e($e" '+" ('te% #$(($4e" ) si!0'st'ti+ i+ 9;;,

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!e'+ %e"u*ti$+ $# LDL-C (e0e( 4ith the !'1i!'( %e*$!!e+"e" "$se $# "i##e%e+t st'ti+

%'+&es #%$! 36 t$ 66./

8


20/85

M'+) ('+"!'%> *(i+i*'( t%i'(s h'0e sh$4+ the e+e#its $# st'ti+s #$% %i!'%) '+"

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"ise'se '+" hi&h $% +$%!'( ($$" *h$(este%$( *$+*e+t%'ti$+s, 's 4e(( 's i+ 's)!t$!'ti*

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P%'0'st'ti+ i+ Is*he!i* Dise'seLIPID, Ch$(este%$( A+" Re*u%%e+t E0e+ts t%i'(CARE,

West $# S*$t('+" C$%$+'%) P%e0e+ti$+ Stu")WOSCOPS '+" Ai% F$%*eTe1's *$%$+'%)

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I+te%0'(CI/6-/89KPJ/22/

;


21/85

55 LDL-C A!$2" .( #"% .%%'!#."( .!"'4%

M'+) stu"ies h'" ee+ i+0esti&'ti+& i+t$ the LDL-C '*hie0e!e+t i+ 'tie+ts 4ith

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'tt'i+!e+t $# LDL-C ) 'tie+ts 0'%ie" i+ e'*h stu")/ A !u(ti+'ti$+'( stu") e1'!i+e"

'tie+ts 4ith "i##e%e+t %is> *'te&$%ies #$u+" th't ' &$$" e%*e+t'&e $# 'tie+ts 'tt'i+e" thei%

LDL-C 4hi*h i+ $0e%'(( 4's 833/ I+ this stu"), the %ese'%*he%s '(s$ #$u+" th't !$st $#

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uti(i


23/85

53 M(#!."#' .(&4!

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the%').2/


24/85

537 M.%,42" ' 2(#!."#' .(&4!

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2


25/85

The !$st *$!!$+() use" i+ the stu") '%e %'te $# %es*%iti$+ %e#i((s %$$ti$+ $# "')s

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3


26/85

Stu") ) C'%$( et al ($$>e" i+t$ the %e('ti$+shi et4ee+ s)*h$($&i*'( '+" *$&+iti0e

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&$'( 'tt'i+t!e+t/

.


27/85

CHAPTER 3

OBECTIVES

(.1 Gene"al Ob,e$ti#es

T$ "ete%!i+e the %$$%ti$+ $# '*hie0e!e+t $# ($4 "e+sit) (i$%$tei+ *h$(este%$( t'%&et, the

'ss$*i'te" #'*t$%s t$ +$+'*hie0e!e+t $# LDL-C t'%&et '+" '"he%e+*e t$ st'ti+ the%') '!$+&

'tie+ts 4ith T)e 2 Di'etes Me((itus/

(.& Spe$i-$ ob,e$ti#es

/ T$ "ete%!i+e the %$$%ti$+ $# ($4 "e+sit) (i$%$tei+ *h$(este%$( t'%&et (e0e(

'*hie0e%s '+" +$+'*hie0e%s '!$+& 'tie+ts 4ith T)e 2 Di'etes Me((itus/

2/ T$ "ete%!i+e the 'tie+ts '"he%e+*e t$ st'ti+ the%') '!$+& 'tie+ts 4ith T)e 2

Di'etes Me((itus/

3/ T$ "ete%!i+e the 'ss$*i'te" #'*t$%s t$ +$+'*hie0e!e+t $# LDL-C t'%&et '!$+&

'tie+ts 4ith T)e 2 Di'etes Me((itus/

3.3 RESEARCH HPOTHESIS

S$*i$"e!$&%'hi* '+" *(i+i*'( #'*t$%s '%e 'ss$*i'te" 4ith the +$+'*hie0e!e+t $# LDL-C

t'%&et/

6


28/85

3.4 Ope"ational e-nition

/ L$4 "e+sit) (i$%$tei+ *h$(este%$(LDL-C '*hie0e!e+t is 'se" $+ the N'ti$+'(

Ch$(este%$( E"u*'ti$+ P%$&%'!!e A"u(t T%e't!e+t P'+e( III/ This stu") $+() !e'su%e" the

&e+e%'( LDL-C t'%&et #$% 'tie+ts 4ith T)e 2 Di'etes Me((itus i+ '**$%"'+*e t$ the

&ui"e(i+e 4hi*h is (ess th'+ 2/7!!$((/ The '*hie0e%s #$% LDL-C t'%&et '%e &%$ue" 's

e($4=

i LDL-C t'%&et '*hie0e%s "i'eti* 'tie+ts 4h$ 'tt'i+e" LDL-C (e0e( J 2/7!!$((

iiLDL-C t'%&et +$+'*hie0e%s "i'eti* 'tie+ts 4h$ 'tt'i+e" LDL-C (e0e( 2/7!!$((

2/ A 'tie+t is *$+si"e%e" t$ '"he%i+& t$ !e"i*'ti$+ i# heshe s*$%e" ' t$t'( e%*e+t'&e $#

86 i+ Me"i*'ti$+ C$!(i'+*e ?uesti$++'i%e/ We "e0i"e" the *'te&$%) $# '"he%e+*e i+

$u% stu") 's e($4=

i- Fu(() '"he%e"= 'tie+ts 4h$ 'tt'i+e" s*$%e i+ MC?ii- A"he%e"= 'tie+ts 4h$ 'tt'i+e" 86 s*$%e i+ MC?iii- N$+'"he%e"= 'tie+ts 4h$ 'tt'i+e" J86 s*$%e i+ MC?

7


29/85

CHAPTER +

METHODOLOG8

+.1 St%y esi/n

This is ' *%$ss se*ti$+'( stu")/

+.& St%y a"ea

This stu") 4's *$+"u*te" i+ @(i+i> R'4't'+ @e(u'%&'@R@, H$sit'( U+i0e%siti

S'i+s M'(')si'HUSM 4hi*h is situ'te" i+ @u'+& @e%i'+, @e('+t'+/ HUSM '(s$ ' *e+t%e

#$% %e#e%%'( #$% 4h$(e st'te $# @e('+t'+/ @(i+i> R'4't'+ @e(u'%&' is '+ $ut'tie+t *(i+i* '+" is

%u+ ) 6 st'##s i+*(u"i+& the F'!i() Me"i*i+e Le*tu%e%s, the F'!i() Me"i*i+e Se*i'(ist i+

t%'i+i+&, !e"i*'( $##i*e%s '+" +u%ses/ D'i() 'tte+"'+*e i+ @R@ %'+&es #%$! 2 t$ 3

'tie+ts/ @R@ is '+ i+te&%'te" *(i+i* '+" Di'etes Me((itus 4's $+e $# the !':$% *h%$+i*

i((+ess 4h$ 0isit @R@/

+.( Pop%lation an sa!ple

937 R4! 1'1,)."#'

Re#e%e+*e $u('ti$+ 4's the 'tie+ts 4ith T)e 2 Di'etes Me((itus i+ @e('+t'+/

8


30/85

935 S',4! 1'1,)."#'

S$u%*e $u('ti$+ 4's the 'tie+ts 4ith T)e 2 Di'etes Me((itus 'tte+"i+& @(i+i>

R'4't'+ @e(u'%&' i+ H$sit'( U+i0e%siti S'i+s M'(')si'/

+.(.( St%y pop%lation

P'tie+ts 4ith T)e 2 Di'etes Me((itus 4h$ 'tte+"e" @(i+i> R'4't'+ @e(u'%&' i+

H$sit'( U+i0e%siti S'i+s M'(')si' #%$! 5'+u'%) 23 t$ M') 23 '+" #u(#i((e" the i+*(usi$+

'+" e1*(usi$+ *%ite%i'/

939 I!),%#' !4#"4#.

/ A&e ; )e'%s $(" '+" '$0e/

2/ P'tie+t "i'&+$se" 4ith T)e 2 Di'etes Me((itus/

3/ P'tie+t "i'&+$se" 4ith D)s(ii"'e!i'/./ Du%'ti$+ $# u+"e%&$i+& st'ti+ the%') 4e%e !$%e th'+ 7 !$+ths/

93 E;!),%#' C4#"4#.

/ P'tie+t 4ith s)*hi't%i* i((+ess $% !e+t'( %et'%"'ti$+/2/ U+'(e t$ %e'" $% 4%ite/3/ T%i&()*e%i"es ./3!!$((

;


31/85

936 S.21)#* 2"&'(

S)ste!'ti* %'+"$! s'!(i+& i+ the %'ti$ =2 'se" $+ 'tie+t 'tte+"'+*e (ist #$% ($$" t'>i+& i+

@R@/

+.(.0 Sa!ple sie $al$%lation

S'!(e si


32/85

Obj!"#$ 5= T$ "ete%!i+e the 'tie+ts '"he%e+*e t$4'%" st'ti+ the%') '!$+& 'tie+ts 4ith

T)e 2 Di'etes Me((itus/

C'(*u('ti$+ $# s'!(e usi+& '42,). %#*) 14'1'4"#'

+ < Q

+ !i+i!u! %eui%e" s'!(e si


33/85

Le0e( $# si&+i#i*'+t /6

P$4e% /;

P /.8P%$$%ti$+ $# LDL '*hie0e%s '!$+& !'(e 'tie+ts.2

P /78 e1e*te" %$$%ti$+ $# LDL +$+'*hie0e%s '!$+& !'(e 'tie+ts

!

The s'!(e si


34/85

T'(e ./ S'!(e si


35/85

+.+ Resea"$* tools

The %ese'%*h t$$(s *$+siste" $#=

C'se %e$%t F$%!/ This se*ti$+ 4's #i((e" u ) i+te%0ie4e%/

'/ S$*i$ "e!$&%'hi* "'t' *$+sists $# i+#$%!'ti$+ %e&'%"i+& '&eK se1K %'*eK !'%it'( st'tusK

s!$>i+& st'tusK $**u'ti$+K i+*$!e '+" e"u*'ti$+ (e0e(/

/ C(i+i*'( "'t' i+#$%!'ti$+ i+*(u"i+& !e"i*'ti$+s +u!e% $# !e"i*'ti$+s '+" t)e $#

st'ti+, i+0esti&'ti$+s %esu(t (ii" %$#i(e '+" HA* '+" e1'!i+'ti$+s 4ei&ht,

hei&ht '+" ($$" %essu%e/

2 Se(# '"!i+iste%e" uesti$++'i%es/ This se*ti$+ 4's #i((e" u ) stu") su:e*ts/

'/ P'tie+ts t%e't!e+t "'t' 4hi*h i+*(u"es i+#$%!'ti$+ '$ut the "u%'ti$+ '+ti*h$(este%$(

!e"i*'ti$+ *$+su!ti$+, >+$4(e"&e '+" si"e e##e*ts $# '+ti*h$(este%$( !e"i*'ti$+

*$+su!e"/

/ Me"i*'ti$+ '"he%e+*e uesti$++'i%e= Me"i*'ti$+ C$!(i'+*e ?uesti$++'i%eMC? 4'suse" i+ this stu")/ It 4's "e0e($e" ) H'ss'+ et '( i+ 27 t$ 'ssess '"he%e+*e

t$4'%"s '+tih)e%te+si0e !e"i*'ti$+.8/ It is *$!%ise" $# ' set $# uesti$+s

4hi*h *$+sists $# 2 "$!'i+s= ' "%u& t'>i+& eh'0i$u% "$!'i+ *$!%isi+& 8 ite!s '+"

' "%u& st$i+& eh'0i$u% "$!'i+ *$!%isi+& 3 ite!s / The i+te%+'( *$+siste+*)

%e'(ii(ities *%$+'*h '(h' 4e%e /78 '+" /;. '+" test-%etest si+&(e !e'su%e

i+t%'*('ss *$%%e('ti$+ *$e##i*ie+t 4e%e /8; '+" /;3/ The s*$%es '%e *'(*u('te" usi+&

the Li>e%t s*'(e %'+&i+& #%$! t$ 6 4ith i+"i*'ti+& +e0e% '+" 6 i+"i*'ti+& 0e%)

#%eue+t/ A(( +e&'ti0e() 4$%"e" s*$%es 4e%e %e0e%se" '+" '(( s*$%es 4e%e *$+0e%te" t$

t$ s*$%e/ P'tie+t 4ith &$$" *$!(i'+*e $% '"he%e+*e 4ith ' s*$%e $# 86

*$%%es$+" 4ith #%eue+t() '+" 0e%) #%eue+t() #$% '(( ite! i+ the uesti$++'i%e/

P'tie+ts 4h$ s*$%e J 86 *$+si"e%e" t$ e i+ the +$+'"he%e+*e &%$u/ Fu(() '"he%e"

&%$u 4e%e th$se 'tie+ts 4h$ s*$%e /23


36/85

P%etest $# uesti$++'i%es= the %etest $# the uesti$++'i%e 4's *$+"u*te" '!$+&

'tie+ts 4ith T2DM $+ st'ti+ the%') 'tte+"e" @(i+i> P'>'% Pe%u't'+, HUSM/ The

*('%it) '+" '%$%i'te+ess $# uesti$+s 4's '+'()


37/85

9 D.". !'))!"#' 14'!(,4

P'tie+ts 4ith T)e 2 Di'etes Me((itus 4h$ 'tte+"e" @R@ #$% *u%%e+t %$uti+e ($$"

i+0esti&'ti$+ "u%i+& the e%i$" $# this stu") 4e%e se(e*te" usi+& s)ste!'ti* %'+"$! s'!(i+&

i+ 2 usi+& the 'tte+"'+*e (ist/ P'tie+ts 4ith T)e 2 Di'etes Me((itus 4h$ #u(#i(( the

i+*(usi$+ '+" e1*(usi$+ *%ite%i' 4e%e i+*(u"e" i+ the stu")/ E(i&i(e stu") su:e*ts 4e%e

&i0e+ i+#$%!'ti$+ '+" e1('+'ti$+ %e&'%"i+& the stu")/ Su:e*ts 4ith *$+se+t si&+e" the

*$+se+t #$%! '+" 4e%e i+te%0ie4e"/ P'tie+ts 4e%e the+ &i0e+ se(# '"!i+iste%e" '+" 0'(i"'te"

*$!(i'+*e uesti$++'i%e t$ *$!(ete

The %ese'%*he% *$!(ete" the %e!'i+i+& i+#$%!'ti$+ +ee"e" 4ith the "'t' t'>e+ #%$!

the 'tie+ts $+(i+e !e"i*'( %e*$%"/ F$% e'*h su:e*t $# the stu"), the $+(i+e ($$" %esu(t '+"

(ist $# !e"i*'ti$+s t'>e+ 4e%e t%'*e" ) >e)i+& i+ the 'tie+ts h$sit'( %e&ist%'ti$+ +u!e%

i+ the $+(i+e %esu(t "'t''se '+" $+(i+e %es*%iti$+ "'t''se/ The %esu(t $# ($$"

i+0esti&'ti$+s (ii" %$#i(e '+" HA* 4e%e t'>e+ #%$! the test "$+e $+ the "') $# the

i+te%0ie4/ I# the ($$" %esu(ts 4e%e +$t '0'i('(e '+" T%)&(i*e%i"e %esu(t sh$4s ' (e0e( $#

!$%e th'+ ./3!!$((, the su:e*ts 4e%e e1*(u"e" #%$! the stu")/

+.2 Statisti$al analysis

D't' e+t%) '+" '+'()sis 4's "$+e usi+& X St'tisti*'( P'*>'&e #$% S$*i'( S*ie+*es SPSS

0e%si$+ 22/ Des*%iti0e st'tisti*s 4's use" t$ '+'()


38/85

+.2.1T*e p"o$e%"e of !%ltiple lo/isti$ "e/"ession

The "ist%iuti$+ '+" #%eue+*ies 4e%e e1'!i+e"/ A(( +u!e%i*'( 0'%i'(es 4e%e

e1%esse" 's !e'+ '+" 96 *$+#i"e+t i+te%0'(/ F%eue+*) '+" e%*e+t'&e 4e%e *'(*u('te" #$%

*'te&$%i*'( 0'%i'(es/ Bi0'%i'te '+'()ses 4e%e e%#$%!e" t$ "ete%!i+e 4hi*h i+"ee+"e+t

0'%i'(es 4e%e 'ss$*i'te" 4ith +$+'*hie0e!e+t $# LDL-C t'%&et/ V'%i'(es 4ith 0'(ue J/26 i+

i0'%i'te !$"e(s '+" *(i+i*'(() si&+i#i*'+t 0'%i'(es 4e%e the+ i+*(u"e" i+ the !u(ti0'%i'te ($&isti*

!$"e(s/ This 0'(ue 4's set ('%&e% th'+ the (e0e( $# si&+i#i*'+*e t$ '(($4 !$%e i!$%t'+t

0'%i'(es t$ e i+*(u"e"/ B'*>4'%" '+" #$%4'%" !eth$"s 4e%e use" #$% the se(e*ti$+ $# 0'%i'(es/

I+ '""iti$+, i+te%'*ti$+ te%!s et4ee+ 0'%i'(es, 'se" $+ eh'0i$%'( $% i$($&i*

('usii(it) 4e%e '**$u+te" #$% t$ 'ssess thei% si&+i#i*'+*e t$ the !u(ti0'%i'te !$"e(s/ Si&+i#i*'+t

i+te%'*ti$+s 4e%e %et'i+e" i+ the #i+'( !$"e(/ Mu(ti*$((i+e'%it) '+" i+te%'*ti$+ 4's +$t *he*>e"

si+*e the%e 4's $+() $+e si&+i#i*'+t 0'%i'(e +$te" #%$! the !u(ti(e ($&isti* %e&%essi$+s/ The+,

%e(i!i+'%) #i+'( !$"e( 4's $t'i+e"/

The #it+ess $# the !$"e( 4's teste" ) H$s!e% '+" Le!esh$4 &$$"+ess $# #it test/ The

!$"e( is e%#e*t() #it i# the 0'(ue '%$'*hes t$ $+e/ The *('ssi#i*'ti$+ t'(e '+" %e*ei0e%

$e%'ti+& *h'%'*te%isti* ROC *u%0e 4's '(s$ use" t$ "ete%!i+e the #it+ess $# the !$"e(/

+.3 Et*i$al $onsie"ation

The %$$s'( $# this stu") 4's %ese+te" t$ the De'%t!e+t $# F'!i() Me"i*i+e '+" Ethi*s

C$!!ittee $# U+i0e%sit) S'i+s M'(')si'/ Ethi*'( '%$0'( 4's %e*ei0e" $+ ; A%i( 22/

Ae+"i1 I/

27


39/85

F#*,4 97 F)'< !&.4" ' "& %",(+

28

REFERENCE POPULATION

P'tie+ts 4ith T)e 2 Di'etes Me((itus $+ st'ti+ the%') i+

@e('+t'+

SOURCE POPULATION

P'tie+t 4ith T)e 2 Di'etes Me((itus $+ st'ti+ the%')

'tte+"i+& @(i+i> R'4't'+ @e(u'%&', HUSM

SAMPLING METHOD

S)ste!'ti* R'+"$! S'!(i+&

SELECTION

I+*(usi$+ '+" e1*(usi$+ *%it%te%i'

RESEARCH TOOLS

• Se(# '"!i+iste%e" uesti$++'i%esC'se Re$%t

F$%!=s$*i$"e!$&%'h) "'t', 'tie+ts t%e't!e+t, Me"i*'ti$+C$!(i'+*e ?uesti$++'i%es

• O+(i+e "'t''se %e*$%"=%es*%iti$+('$%'t$%)%esu(t

• E1'!i+'ti$+ t$$(s=s)&!'+$!ete%, 4ei&hi+&s*'(e !e'su%i+ t' e

DATA ENTRY AND ANALYSIS


40/85

LDL4C ta"/et a$*ie#e!ent in T&D'56ECP4ATP III7

ADHERENCE-comply to treatment

-multidimension( socio-economic, health care system, condition related, patient related, therapy relat

LDL4C ta"/et a$*ie#e"s


41/85

CHAPTER 2

RESULT

A t$t'( $# 23. "i'eti* 'tie+ts 4ith u+"e%()i+& ")s(ii"'e!i' 'tte+"e" @(i+i> R'4't'+

@e(u'%&' 4e%e e(i&i(e '+" '%ti*i'te" i+ the stu")/ The %es$+se %'te 4's 92/;/

2.1 So$io4e!o/"ap*i$ $*a"a$te"isti$ of "esponents

The !e'+ '&e $# the %es$+"e+ts 4's 69/29/2 )e'%s $("// The !'(e '+" #e!'(e

%es$+"e+ts i+0$(0e" 4e%e '(!$st eu'( i+ +u!e%/ M':$%it) $# the %es$+"e+ts 4e%e M'(')/

M$%e th'+ h'(# $# the %es$+"e+ts76/; *$!(ete" thei% se*$+"'%) s*h$$(/ The s$*i$-

"e!$&%'hi* *h'%'*te%isti*s $# %es$+"e+ts 4e%e sh$4+ i+ T'(e 6//

T.b) 7 : S'!#'-(2'*4.1! !&.4.!"4#%"#! ' 4%1'("%

V'%i'(es !e'+ZSD Dist%iuti$+ $# %es$+"e+ts +23.

Pe%*e+t'&es

A&e Ye'%sZSD 69/2Z9/2

Se1

M'(e

Fe!'(e

3

3

../

67/

R'*e

M'(')

Othe%s

23

9

9

M'%it'( st'tus

M'%%ie"

U+!'%%ie" 4i"$4

29

26

;9/3

/8

29


42/85

E"u*'ti$+

P%i!'%)

Se*$+"'%)

Te%ti'%)

62

6.

2;

22/3

76/;

2/

I+*$!e

RM8

RM8

7

;

.9/7

6/.

2.& Clini$al $*a"a$te"isti$s of "esponants

M':$%it) $# %es$+"e+ts 4e%e +$+s!$>e%97/ M':$%it) $# the %es$+"e+ts 4e%e

%es*%ie" 4ith ' t$t'( $# . $% !$%e t)es $# !e"i*'ti$+s '+" At$%0'st'ti+ 4's the !$st

*$!!$+ st'ti+ %es*%ie"7;/;/ H'(# $# the %es$+"e+ts6/. 4e%e '(%e'") $+ st'ti+ #$%

t$ 6 )e'%s/ H$4e0e% !$st $# the %es$+"e+ts "i" +$t e1e%ie+*e '+) si"e e##e*ts $# st'ti+

the%');9/8/ The !e'+ BMI, SBP, DBP, HA* '+" LDL 4e%e 27/.6/3 >&!2 ,

3./7/; !!H&, ;/29/7; !!H&, 8/92/9 '+" 2/97/97 !!$(( %ese*ti0e()/

The *(i+i*'( *h'%'*te%isti*s $# %es$+"e+ts 4e%e sh$4+ i+ t'(e 6/2/

3

C$+ti+ue T'(e 6/


43/85

T'(e 6/2= C(i+i*'( *h'%'*te%isti*s $# %es$+"'+ts

V'%i'(es Me'+ZSD Dist%iuti$+ $# %es$+"e+ts+23.

Pe%*e+t'&es

S!$>i+& st'tus S!$>e%

N$+s!$>e%

9

226

3/;

97/2

Nu!e% $# %es*%ie"!e"i*'ti$+s

J.

.

62

;2

22/2

88/;

Wei&ht>&

Hei&ht*!

BMI>&!2

77/6Z./3

6;/.Z8/68

27/.Z6/3

S)st$(i* BP

!!H&

Di'st$(i*BP!!H&

3./Z7/;

;/2Z9/7;

HA* 8/92Z/9

T$t'(Ch$(este%$(!!$((

LDL!!$(( J2/7

2/7

./;9Z/3

2/97Z/97;;

.7

38/7

72/.T%i&()*e%i"e /76Z/83HDL /23Z/27

Du%'ti$+ $+ st'ti+

3

C$+ti+ue T'(e 6/2


44/85

7!th t$ )%

)% t$ 6)%

M$%e th'+ 6 )%

.9

;

78

2/9

6/.

2;/7

T)es $# st'ti+

L$0'st'ti+

Si!0'st'ti+

At$%0'st'ti+

P%'0'st'ti+

.6

7

;

./3

9/2

7;/;

8/8

@+$4(e"&e $# t)e

$# st'ti+ t'>e+ Yes

N$

.9

;6

2/9

89/

@+$4(e"&e $# "$se

$# st'ti+ t'>e+

Yes

N$

67

8;

23/6

87/6

Si"e e##e*t

e1e%ie+*e" )

'tie+ts

N$ si"e e##e*t

GI uset

!)'(&i'Othe%s

2

6

36

;9/8

7/.

/32/6

32


45/85

2.( P"opo"tion of LDL4C /oal a$*ie#e"s an nona$*ie#e"s

The %$$%ti$+ $# LDL &$'( '*hie0e%s '+" +$+'*hie0e%s '!$+& 'tie+ts 4ith T)e 2

Di'etis Me((itus $+ st'ti+ the%') 'tte+"i+& @(i+i> R'4't'+ @e(u'%&', HUSM 4'si((ust%'te" i+ #i&u%e 6//

Fi&u%e 6/= The %$$%ti$+ $# LDL *h$(este%$( '*hie0e!e+t '!$+& 'tie+ts 4ith T)e 2

Di'etes Me((itus/

30.!

!.4

Achieers(1D1


46/85

2.+ Pe"$enta/e of a*e"en$e to statin t*e"apy

The e%*e+t'&e $# 'tie+ts 4ith T)e 2 Di'etes Me((itus i+ '"he%e+*e t$ st'ti+ the%') 4's

i((ust%'te" i+ #i&u%e 6/2/

Fi&u%e 6/2 = The e%*e+t'&e $# 'tie+ts 4ith T)e 2 Di'etes Me((itus i+ '"he%e+*e t$ st'ti+

the%')

4

4

5ully adhered

AdheredNonadhered

3.


47/85

2.2 T*e asso$iate fa$to"s to nona$*ie#e!ent of LDL4C

ta"/et a!on/ patients )it* Type & Diabetes 'ellit%s

2.2.1 T*e asso$iate fa$to"s to nona$*ie#e!ent of LDL4C ta"/et

by Si!ple Lo/isti$ "e/"ession

The s*%ee+i+& #$% s$*i$"e!$&%'hi* '+" *(i+i*'( #'*t$%s 4's e%#$%!e" th%$u&h si!(e

($&isti* %e&%essi$+/ A&e, BMI, SBP, HA* '+" 'tie+tss >+$4(e"&e $# "$se $# st'ti+ t'>e+

'%e 't the 0'(ue J /26/ The 0'%i'(es 4ith ' 0'(ue $# J/26 '+" *(i+i*'(() $% i$($&i*'(()

si&+i#i*'+t 0'%i'(es 4e%e i+*(u"e" #$% #u%the% '+'()sis i+ Mu(ti(e L$&isti* Re&%essi$+/ The

%esu(ts $# si!(e ($&isti* %e&%essi$+ 4e%e sh$4+ i+ t'(e 6/6/ '+" t'(e 6/6/2/

T'(e 6/3= Ass$*i'ti$+ et4ee+ s$*i$"e!$&%'hi* #'*t$%s '+" +$+'*hie0e%s $# LDL-C t'%&et

s*%ee+i+& ) Si!(e L$&isti* Re&%essi$+/

S$*i$"e!$&%'hi*

0'%i'(es

Re&%essi$+

*$e##i*ie+t

C%u"e OR 96CI W'(" st'tisti*

0'(ue

A&e )e'%-/27 /98/96-/ 3/6 /;3

Se1M'(eFe!'(e /78

//;/79-2/ /389 /63;

M'%it'( st'tus

M'%%ie"

U+!'%%ie" 4i"$4 /88

/

/;/.7-2/67 /3 /;7

R'*e

M'(')

N$+!'(') /26

/

/23/.;-3/8 /89 /782

E"u*'ti$+

36

C$+ti+ue T'(e 6/3


48/85

N$ #$%!'(e"u*'ti$+ P%i!'%)

Se*$+"'%)

Te%ti'%)

/272

/78.

/.3

/

/3/2.-8/.

/97/3;-/7

/6/2-7/8.

2/9.

/9

/762

/26

/.

/873

/.9

/;8.

I+*$!e

RM8

RM8 -/9

/

/;3/.9-/. /6 /.89

T'(e 6/.= Ass$*i'ti$+ et4ee+ *(i+i*'( "'t' '+" +$+'*hie0e%s $# LDL-C t'%&et s*%ee+i+& )

Si!(e L$&isti* Re&%essi$+

C(i+i*'( 0'%i'(es Re&%essi$+

*$e##i*ie+t

C%u"e OR 96CI W'(" st'tisti* 0'(ue

S!$>i+& st'tus

N$+s!$>e% S!$>e% /9.

//2/3-./9;

/83 /8;;

Nu!e% $# %es*%ie"

!e"i*'ti$+s

J.

. -/77

/

/;6/.6-/7

/266 /7.

BMI -/39 /97/92-/ 2/3;9 /22

SBP -/6 /99/98-/ 3/288 /8

DBP -/8 /993/97-/2 /262 /77

HA* /237 /28/;-/.9 ;/228 /.

37


49/85

Du%'ti$+ $+ st'ti+

7!th t$ )%

)% t$ 6 )%

M$%e th'+ 6)%

/83

-/26

/

/9/7-2/38

/;;/.2-/;8

/93;

/2..

/8

/727

/72

/8..

@+$4(e"&e $# t)e $#

st'ti+ t'>e+

N$

Yes -/28;

/

/87/.-/.2 /827

/39.

@+$4(e"&e $# "$se $#

st'ti+ t'>e+

N$ Yes -/627

//69/32-/9 2/;32

/92

T)es $# st'ti+

L$0'st'ti+

Si!0'st'ti+

At$%0'st'ti+

P%'0'st'ti+

/.6

/.9.

/263

/

/6/3;-6/9.

/739/.67-6/;9

3/6/77-;/6

2/.;6

/33.

/683

2/86

/..;

/673

/..9

/.

A"he%e+*e t$ st'ti+

the%')

Fu(() '"he%e"

A"he%e"

N$+'"he%e"

/737

/99

/

/;9/99-3/69

3//29-3/9

./3

3/869

/;62

/33

/63

/367

2.2.& T*e Asso$iate fa$to"s to nona$*ie#e!ent of LDL4C ta"/et

by '%ltiple Lo/isti$ Re/"ession

The $+() si&+i#i*'+t #'*t$% 'ss$*i'te" 4ith +$+'*hie0e%s $# LDL-C t'%&et 4's the

HA* (e0e( 4he+ the *$+#$u+"e%s 4e%e ei+& *$+t%$((e"T'(e 6/6/38


50/85

T'(e 6/6= Ass$*i'te" #'*t$%s t$ +$+'*hie0e!e+t $# LDL-C t'%&et ) Mu(ti(e L$&isti*Re&%essi$+

V'%i'(es Re&%essi$+

*$e##i*ie+t

A":uste" OR '

96CI

W'(" st'tisti*"#

P 0'(ue

HA* /237 /277/;-/.9

;/228

/.

'F$%4'%" LR Mu(ti(e L$&isti* Re&%essi$+ 4's '(ie"

The i+te%'*ti$+ '+" !u(ti*$((i+e'%it) 4e%e +$t %$*ee"e" '**$u+ti+& th't $+() $+e #'*t$% 4's

si&+i#i*'+t/

M$"e( #it+ess 4's *he*>e" ) H$s!e% Le!esh$4 &$$"+ess-$#-#it test, *('ssi#i*'ti$+ t'(e '+"

'%e' u+"e% ROC Re*ei0e% Oe%'ti+& Ch'%'*te%isti*s *u%0e/ The 0'(ue #$% H$s!e%

Le!esh$4 &$$"+ess-$#-#it test 4's +$t si&+i#i*'+t/27./ The *('ssi#i*'ti$+ t'(e sh$4e"

th't 76/. $# *'ses 4e%e %e"i*te" *$%%e*t() 4hethe% the) 4e%e +$+'*hie0e%s $% '*hie0e%s $#

LDL-C t'%&et/ The '%e' u+"e% the *u%0e $# ROC 4's /77/ The !$"e( *'+ '**u%'te()

"is*%i!i+'te 7/7 $# the *'ses it is si&+i#i*'+t t$ "is*%i!i+'te !$%e th'+ h'(# $# *'ses/ The

The %e(i!i+'%) !$"e( 4's '**ete" #$% the #i+'( !$"e( 'se" $+ H$s!e% Le!esh$4

&$$"+ess-$#-#it test '+" ROC *u%0e 's *('ssi#i*'ti$+ t'(e "i" +$t %$"u*e ' &$$" 0'(ue/

I"414"."#' ' M,)"#1) L'*#%"#! R*4%%#'

A 'tie+t 4ith T)e 2 Di'etes Me((itus 4h$ h'" '+ i+*%e'se $# HA* h's /3 ti!es the

$"" t$ e*$!e +$+'*hie0e%s LDL-C t'%&et 96 CI /;,/.9,J/6/

3;


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The%e#$%e, i+*%e!e+t $# HA* (e0e( 4i(( i+*%e'se the *h'+*e $# 'tie+t 4ith T)e 2

"i'etes Me((itus t$ e*$!e +$+'*hie0e%s $# LDL-C t'%&et ) /3/

39


52/85

CHAPTER 3

DISCUSSION

3.1 P"opo"tion of LDL4C /oal a$*ie#e"s an nona$*ie#e"s

a!on/ patients )it* Type & Diabetes 'ellit%s

This stu") %e0e'(e" th't the LDL-C &$'( '*hie0e%s '!$+& 'tie+ts 4ith T)e 2

Di'etes Me((itus 4e%e 38/7/ It is +$t ' sh$*>i+& %esu(t 's this e%*e+t'&e 4's '(!$st si!i('%

4ith the #i&u%e #%$! N'ti$+'( Di'etes Re&ist%) NDR th't 4's *$+"u*te" #%$! 29 t$

22 't %i!'%) *'%e *(i+i*s i+ M'(')si' 4hi*h )ie(" the %esu(t $# 38/; .;/ NDR 4's '+

i+iti'ti0e $# the M'(')si' Mi+ist%) $# He'(th i+ e0'(u'ti+& the t'%&et '*hie0e!e+t '+" *(i+i*'(

$ut*$!es i+ 'tie+ts 4ith "i'etes 4h$ 4e%e !'+'&e" 't %i!'%) he'(th *'%e *(i+i*s/

H$4e0e%, the su:e*ts stu"ie" ) the NDR sh'%e" the s'!e *h'%'*te%isti*s $# su:e*t stu"ie"

su*h 's u+"e%()i+& Di'etes Me((itus, si!i('%ities i+ eth+i*it) '+" &e$&%'hi*'( %e&i$+/

M'#'u


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G($'(() the t%e+" $# LDL-C &$'( '*hie0e!e+t %'+&es #%$! ; t$ 83 ut the%e

4e%e "i##e%e+*es i+ the $u'('ti$+ &%$u stu"ie"2;, 3, 32, 33/ H$4e0e%, $u% #i+"i+&

sh$4e" ' ($4e% e%*e+t'&e *$!'%e" t$ ' ('%&e !u(ti+'ti$+'( 'tie+t $u('ti$+ stu")

i+0$(0i+& 9 *$u+t%ies 4hi*h i((ust%'te" the e%*e+t'&e $# 78 , 8. '+" ;7 '*hie0e!e+t $#

LDL-C i+ hi&h %is>, !$"e%'te %is> '+" ($4 %is> 'tie+ts6/ The t'%&et $# LDL-C 4's 'se"

$+ the NCEP-ATP III %e*$!!e+"'ti$+/ The stu") '(s$ i+*(u"e" 0'%i$us #$%! $# (ii"

($4e%i+& the%') ut '(!$st 86 $# the su:e*ts 4e%e $+ st'ti+ the%') '+" 't$%0'st'ti+ 4's

the !$st *$!!$+() use" 's i+ th't stu")/ We '(s$ +$te" th't i+ $u% stu"), !$%e th'+ h'(# $#

the su:e*ts7;/; 4's $+ 't$%0'st'ti+/ The e%*e+t'&e $# '*hie0e!e+t $# LDL-C 4's

"$u(e" i+ the hi&h %is> &%$u i+ *$!'%is$+ t$ $u% stu")/ The *$u+t%ies th't i+0$(0e" i+ the

stu") 4e%e the U+ite" St'tes $# A!e%i*', C'+'"', F%'+*e, Nethe%('+"s, S'i+, B%'e" i+t$ the '*hie0e!e+t 4ith ' ($4e% t'%&et $# /;!!$(( i+ '**$%"'+*e 4ith the NCEP.


54/85

&ui"e(i+e 4hi*h %e0e'(e" '$ut .3/. $# 'tie+ts '*hie0i+& thei% LDL-C t'%&et28/ The)

#$u+" th't e0e+ i+ ' &$$" he'(th *'%e s)ste! '+" ' "e"i*'te" te'! t%e'ti+& ")s(ii"'!i' the%e

4e%e sti(( "i##i*u(ties i+ &etti+& the !':$%it) $# 'tie+ts t$ '*hie0e the t'%&et/ I+ the stu"), the

'tie+ts %e*ei0e" st'ti+ !$+$the%'), +$+st'ti+ the%') '+" *$!i+'ti$+ (ii" ($4e%i+&

the%') '+" the %esu(t sh$4e" th't the !':$%it)92/. $# the LDL &$'( '*hie0e%s 4e%e

%e*ei0i+& st'ti+ !$+$the%') $% i+ *$!i+'ti$+/

Si+*e $u% stu") 4's *$+"u*te" '!$+& 'tie+ts 4ith ' hi&h %is> #$% *'%"i$0's*u('%

"ise'se, 4e e1e*te" th't the e%*e+t'&e $# 'tie+ts '*hie0i+& the LDL-C t'%&et 4$u(" e

hi&he% 's !$st $# the %e0i$us stu"ies sh$4e" ette% '*hie0e!e+t $# the LDL-C t'%&et

*$!'%e" t$ the 'tie+ts i+ the ($4 t$ !$"e%'te %is> &%$us/

3.& Pe"$enta/e of a*e"en$e to statin t*e"apy an

"elations*ip )it*

LDL4C ta"/et a$*ie#e!ent

We %e$%te" ' hi&h %'te $# '"he%e+*e t$ st'ti+ the%') 4hi*h 4's 9;/3/ A$ut 2/6 $#

the 'tie+ts 4e%e '"he%i+& #u(() s*$%e $# MC? '+" 88/; $# the 'tie+ts 4e%e

'"he%i+& 86/ It %e#(e*te" th't $u% $u('ti$+ h'" ' ette% '"he%e+*e %'te t$ (ii" ($4e%i+&

the%') *$!'%e" t$ $the% t%e't!e+t $# *h%$+i* i((+esses su*h 's "i'etes $% h)e%te+si$+/

This stu") %e0e'(e" ' 0e%) ($4 +$+'"he%e+*e %'te t$ st'ti+ the%') 't /8 '!$+&

'tie+ts 4ith ")s(ii"'e!i' '+" T)e 2 Di'etes Me((itus 4h$ h'" 'tte+"e" @R@, HUSM/

.2


55/85

This #i&u%e 4's e1t%e!e() ($4 *$!'%e" t$ $the% stu"ies th't 4hi*h %e*$%"e" the

+$+'"he%e+*e %'te 't 38 t$ 63;, ., .2/ The $ssii(ities $# su*h %esu(t *$u(" e "ue t$

the "i##e%e+t !eth$" $% t$$(s '"!i+iste%e" i+ 'ssessi+& '"he%e+*e, !isu+"e%st'+"i+& "u%i+&

'+s4e%i+& the se(# '"!i+iste%e" uesti$++'i%e '+" $u% su:e*ts h'0i+& &$$" '"he%e+*e t$

st'ti+ the%')/ I+te%0ie4 '+" '(( se(# %e$%te" !eth$"s '%e 0u(+'%'(e t$ $0e%esti!'tes $#

*$!(i'+*e '+" u+"e%esti!'te $# +$+*$!(i'+*e.3/

A %e0ie4 $# '%ti*(e ) C%'!e% et al %e&'%"i+& *$!(i'+*e '+" e%sist'+*e i+ the t%e't!e+t

$# "i'etes, h)e%te+si$+ '+" ")s(ii"'e!i' sh$4e" th't Me"i*'ti$+ P$ssessi$+ R'ti$MPR

4's the *$!!$+() use" !eth$"3;/ M$st $# the stu"ies $+ '"he%e+*e t$ !e"i*'ti$+ use"

si!(e% uesti$++'i%e su*h 's MMAS 4ith '+s4e% $ti$+s $# yes $% no 38, 39, .2, 62/ Ou%

stu") use" ' 0'(i"'te" Me"i*'ti$+ C$!(i'+*e ?uesti$++'i%es 4's %e0i$us() use" i+

*$!(i'+*e t$ '+tih)e%te+si0e '+" $%'( h)$&()*'e!i* '&e+t.8/ This uesti$++'i%e is !$%e

*$!(e1 *$!'%e" t$ MMAS e*'use it *$+t'i+s ite!s '+" 'tie+t +ee" t$ *h$$se

suit'(e '+s4e%s i+ the #$%! $# Li>e%t s*'(enever, seldom, sometimes, freuent and very

freuent ut the$%iti*'(() it 4i(( )ie(" ' !$%e '**u%'te '"he%e+*e %esu(t/ A stu") "i" '

*$!'%is$+ et4ee+ the Li>e%t s*'(e '+" t%'"iti$+'( !e'su%es $# se(# e##i*'*) '+" the %esu(ts

i+"i*'te" th't Li>e%t-t)e '+" t%'"iti$+'( !e'su%es $# se(#-e##i*'*) h'0e ' si!i('% %e(i'i(it)

e%%$% 0'%i'+*e, %$0i"e eui0'(e+t (e0e(s $# %e"i*ti$+, '+" h'0e si!i('% #'*t$% st%u*tu%e '+"

si!i('% "is*%i!i+'i(it)63/ ?uesti$++'i%es '%e e's) t$ e use" ut *'+ e sus*eti(e t$

!is%e%ese+t'ti$+ '+" te+"s t$ *'use the he'(th *'%e %$0i"e%s t$ $0e%esti!'te the 'tie+ts

'"he%e+*e36/ The use $# !e"i*'ti$+ uesti$++'i%e s*'(e 4's *$!'%e" t$ h'%!'*) #i((s %'te

'+" the) #$u+" th't the *$+*$%"'+*e 4's 86 '+" MMAS si&+i#i*'+t() 'ss$*i'te" 4ith

h'%!'*) %e#i(( '"he%e+*e6./

H$4e0e%, the%e 4e%e +$ &$(" st'+"'%" est'(ishe" i+ 'ssessi+& 'tie+ts '"he%e+*e t$

!e"i*'ti$+s36/ The "e*isi$+ t$ *h$$se the !eth$" $# 'ssessi+& '"he%e+*e is "ee+"e+t

.3


56/85

u$+ the %ese'%*he% '+" ) '**$u+ti+& #$% the #'*t$%s su*h 's '**u%'*), '0'ii(it), si!(i*it),

'"0'+t'&es '+" '$%i'te+ess/

Be%!i+&h'! et al h'" '"!i+iste%e" the MMAS '"he%e+*e uesti$++'i%e '+" %e$%te" th't

69/2 $# LDL-C '*hie0e%s 4e%e #u(() '"he%e" '+" 39/7 $# LDL-C +$+'*hie0e%s 4e%e #u(()

'"he%e"/ I+ $u% stu"), $th LDL-C '*hie0e%s '+" LDL-C +$+'*hie0e%s h'" '+ eu'(

e%*e+t'&e $# 'tie+ts th't 4e%e '"he%i+& #u(() t$ st'ti+ the%')/ The '"he%e+*e $# 'tie+ts "i"

+$t %e0e'( '+) si&+i#i*'+t "i##e%e+*e t$ the LDL-C '*hie0e!e+t/ H$4e0e%, %$se*ti0e

'+'()sis $# LDL-C &$'( '*hie0e!e+t '!$+& st'ti+ use% i+ the %i!'%) *'%e %e0e'(e" th't the

#'*t$% !$st 'ss$*i'te" 4ith LDL-C t'%&et '*hie0e!e+t 4's MMAS s*$%e.2/

H'ss'+ et al h'" 0'(i"'te" Me"i*'ti$+ C$!(i'+*e ?uesti$++'i%eMC? '+" 'ssesse" the

*$!(i'+*e $# 'tie+ts t$4'%" '+tih)e%te+si0e !e"i*'ti$+.8/ MC? %e0e'(e" 66/; $#

'tie+ts +$t '"he%e" t$ the !e"i*'ti$+/ H$4e0e%, the use" $# si!i('% t$$( i+ this stu")

%e$%te" ' hi&h '"he%e+*e %'te/ The hi&he% '"he%e+*e %'te i+ $u% s'!(e e0e+ th$u&h usi+&

si!i('% t$$( *$u(" e e*'use $# si!(e% "$si+& $# st'ti+ *$!'%e" t$ '+tih)e%te+si0es 4hi*h

*'+ e &i0e+ 's t4i*e e0e+ t%i*e "'i()/

A**$%"i+& t$ C'su(' et al , '"0e%se e##e*ts $# the st'ti+ 4's $+e $# the i!$%t'+t *'use $#

+$+'"he%e+*e/ The) %e$%te" th't 3 t$ 72 "is*$+ti+u'ti$+ $# st'ti+ the%') 4's "ue t$ the

si"e e##e*ts $# st'ti+66/ I+ $u% stu"), /2 $# %es$+"e+ts h'" e1e%ie+*e si"e e##e*ts $#

st'ti+ '+" 3/; $# %es$+"e+ts h'" h'" hist$%) $# "is*$+ti+ui+& st'ti+ "ue t$ its si"e e##e*ts/

The ($4 i+*i"e+*e $# si"e e##e*ts '!$+& these 'tie+ts *$u(" *$+t%iute t$ the hi&h '"he%e+*e

%'te '!$+& these 'tie+ts/

..


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3.( T*e asso$iate fa$to"s to nona$*ie#e!ent of LDL4C

ta"/et

3.(.1So$ioe!o/"ap*i$ fa$to"s

T$ $u% su%ise, '(( %esu(t $# the s$*i$"e!$&%'hi* 0'%i'(es teste" i+ $u% stu") tu%+e"

$ut +e&'ti0e/ This stu") %e0e'(e" th't '&e, &e+"e%, !'%it'( st'tus, e"u*'ti$+ (e0e( '+"

h$useh$(" i+*$!e "i" +$t h'0e '+) 'ss$*i'ti$+ t$ the +$+ '*hie0e!e+t $# the LDL-C t'%&et/

This #i+"i+& 4's i+ *$+t%'%) t$ the %e0i$us stu") th't e0i"e+t() sh$4e" the

s$*i$"e!$&%'hi* 0'%i'(es 's i!$%t'+t %e"i*t$%s #$% LDL-C '*hie0e!e+t28, 3-32, 67/

W'te%s et al $site" th't &e$&%'hi*'( %e&i$+J/, !'(e &e+"e%J/, $("e%

'&eJ/ '+" %'*eAsi'+4hite('*>KJ/ 4e%e %e"i*t$%s #$% su**ess#u( LDL-C

&$'( '*hie0e!e+t3/ C('%> et al '+'()e" i+t$

the eth+i* "i##e%e+*es i+ the '*hie0e!e+t $# the *h$(este%$( t%e't!e+t &$'(/ The) #$u+" th't

A#%i*'+ A!e%i*'+ h'" ' ($4e% su**ess %'te i+ '*hie0i+& the LDL-C t'%&et *$!'%e" t$ N$+

His'+i* White/ @'u##!'+ et al e0'(u'te" the LDL-C '*hie0e!e+t '!$+& 'tie+ts 4ith

*$%$+$%) '%te%) "ise'se '+" thei% %esu(t i((ust%'te" ' si!i('% #i+"i+& th't the (i>e(ih$$" $# $("e%

'tie+ts '+" !e+ 'tie+ts t$ 'tt'i+ the &$'( 4e%e !$%e si&+i#i*'+t/

Ou% stu") 4's i+ *$+*$%"'+*e 4ith the stu") "$+e ) Be%!i+&h'! et al 4he%e i+ it

4's "is*$0e%e" th't '&e '+" &e+"e% #'*t$%s 4e%e +$t 'ss$*i'te" 4ith the '*hie0e!e+t $# LDL-

C &$'(/ A+$the% stu") 4hi*h s*%uti+i


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I+ the stu") ) @'u##!'+ et al , ' +u!e% $# "i##e%e+*es 4e%e +$te"K the

*h'%'*te%isti*s i+*(u"e Ch%$+i* Dise'se S*$%eCDS, '&e, se1, BMI, hi&hest (e0e( $# LDL-C

%e*$%"e", ' "i'etes !e((itus, *$+&esti0e he'%t "ise'se, &$ut, h)e%te+si$+ '+" *$u+t $#

*$%$+$%) '%te%) "ise'se %is> #'*t$%s28/ This is the $+() stu") th't h's +$te" !'+)

"i##e%e+*es i+ $th '*hie0e%s '+" +$+'*hie0e%s &%$u $ssi() "ue t$ the hu&e +u!e% $#

su:e*ts/ Lii" T%e't!e+t Assess!e+t P%$:e*t L[TAP %e$%te" ' ('%&e %$$%ti$+72 $#

")s(ii"e!i* 'tie+ts i+ the U+ite" St'tes 4h$ '%e ei+& t%e'te" i+ ' %i!'%) *'%e setti+& '%e

+$t '*hie0i+& the NCEP t'%&et LDL-C (e0e(32/ Th$se 't hi&hest CHD %is> '%e (e'st (i>e() t$

%e'*h the t'%&et LDL-C (e0e( A#%i*'+-A!e%i*'+s '%e (ess (i>e() th'+ Whites $% His'+i*s t$

'*hie0e these &$'(s/32/

A#$+s$ et al +$te" th't the LDL-C t'%&et '*hie0e%s 4e%e si&+i#i*'+t() $("e% th'+

+$+'*hie0e%s /233/ The !e'+ '&e #$% LDL-C '*hie0e%s i+ $u% stu") 4's

7/7SD;/7. 0s 6;/.SD9/.8K/;/ @'u##!'+ et al '(s$ i((ust%'te" the si&+i#i*'+t

"i##e%e+*e i+ the '&e // H$4e0e%, !$st $# e1isti+& stu"ies #'i(e" t$ sh$4 si!i('%

%esu(t28, 32, .2/ A stu") ) Be%!i+&h'! et al i+ %i!'%) *'%e *(i+i*s '(s$ sh$4e" +$

si&+i#i*'+t "i##e%e+*es i+ '&e, SBP, DBP '+" BMI ut the) +$ti*e" ' si&+i#i*'+t "i##e%e+*e i+

'"he%e+*e t$ "%u& the%') i+ $th &%$us/ The '0e%'&e s*$%e #$% '"he%e+*e usi+& MMAS 4's

($4e% i+ +$+'*hie0e%s &%$u 3/SD/99 0s 3/.SD/93K/29 .2/

635 C)##!.) .!"'4%

The %esu(t $# this stu") su&&ests th't $+() si&+i#i*'+t #'*t$% th't is 'ss$*i'te" 4ith

+$+'*hie0e!e+t $# LDL-C t'%&et 4's HA*A"uste" OR/3 96 CI /;,/.9,J/6/

.7

http://var/www/apps/conversion/tmp/scratch_3/HYPERLINK%23_ENREF_32http://var/www/apps/conversion/tmp/scratch_3/HYPERLINK%23_ENREF_32


59/85

The %esu(t $# $u% stu") sh$4e" th't '+ i+*%e!e+t $# $# the HA* (e0e( 4i(( i+*%e'se the

*h'+*e $# 'tie+t 4ith ")s(ii"'e!i' '+" T)e 2 "i'etes Me((itus t$ e*$!e +$+'*hie0e%s $#

LDL-C t'%&et/

We #$u+" #e4 stu"ies "es*%ie" the 'ss$*i'ti$+ $# HA* 4ith LDL-C (e0e( , 6;-

7/ Ou% stu") *$+#i%!e" %e0i$us #i+"i+&s th't HA* 's ' %e"i*t$% !'%>e% #$% *h$(este%$(

(e0e(69, 7/ @h'+ et al *(e'%() "e!$+st%'te" i+ thei% stu") th't HA* h'" ' "i%e*t '+"

si&+i#i*'+t *$%%e('ti$+ 4ith *h$(este%$(, t%i&()*e%i"es, LDL-C '+" i+0e%se *$%%e('ti$+ 4ith

HDL7/ The) stu"ie" $th #e!'(e '+" !'(e "i'eti* 'tie+ts ut the #i+"i+& sh$4e" th't the

%esu(t h'" +$ "i##e%e+*es i+ te%! $# &e+"e%/ Si!i('% #i+"i+&s '(s$ h'" ee+ "es*%ie" i+ $u%

stu")/ W'&+e% et al ($$>e" i+t$ the e##e*t $# i!%$0i+& &()*'e!i* *$+t%$( $+ LDL-C '%ti*(e

si


60/85

As LDL-C *'++$t e !e'su%e" i+ *e%t'i+ *i%*u!st'+*es su*h 's t%i&()*e%i"es ./3,

Ni%':'+ et al $se%0e" ' si&+i#i*'+t *$%%e('ti$+ et4ee+ &()*'e!i* *$+t%$( '+" (ii" %'ti$

i+*(u"i+& t%i&()*e%i"eHDL %'ti$, t$t'( *h$(este%$(HDL %'ti$ '+" LDLHDL %'ti$6;/

T%i&()*e%i"eHDL %'ti$ is '(s$ ' >+$4+ i+"i*'t$% $# LDL-C '%ti*(e sie% *''*it) 4he%e 's ' &()*'e!i* *$+t%$( 's 4e(( 's ' LDL-C i+"i*'t$%69, 7, 72/

We thi+> th't 'tie+t 4ith ette% &()*'e!i* *$+t%$( 4$u(" '"he%e ette% t$ !e"i*'ti$+ '+"

the%'euti* (i#est()e/ B$th $# this *$+"iti$+ 4$u(" *$+t%iute t$ ette% *$+t%$( $# $the% t'%&et i+

"i'etes su*h 's *h$(este%$( (e0e(/ Bi$*he!i*'((), the e1('+'ti$+ $# %e('ti$+ et4ee+ HA*

'+" (ii" %$#i(e 4's "es*%ie" ) se0e%'( stu"ies/ Li$%$tei+ !et'$(is!s i+ T2DM 'tie+ts

'%e '(te%e" i+ se0e%'( 4')s/ I+su(i+ sti!u('tes (i$%$tei+ (i'se '*ti0it)/ P'tie+ts 4ith T2DM

4h$ e1hiit $th i+su(i+ "e#i*ie+*) '+" i+su(i+ %esist'+*e h'" %e"u*e i+ (i$%$tei+ (i'se

'*ti0it)73/ H)e%&()*'e!i' 4ith !$"e%'te t$ se0e%e i+te+sit) h's "e*%e'se %'te $# *(e'%'+*e

#$% LDL '$%$tei+ B73/ LDL-C i+"i+& t$ the %e*et$% 't e+"$the(iu! $# the 0esse( '(s$

%e"u*e i+ T2DM 's it 4's sti!u('te" ) i+su(i+/ A'%t #%$! th't, i+su(i+ i+hiit the hu!'+

se+siti0e '*ti0it) '+" (e'"i+& t$ the i+*%e'se %$"u*ti$+ $# #%ee #'tt) '*i" #%$! t%i&()*e%i"e/

Pete%s et al "es*%ie" th't %ese+*e $# '+$%!'( t%i&()*e%i"es !et'$(is! '+"$% (ii" t%'+s#e%

'*ti0it) (e'"i+& t$ '(te%'ti$+ $# (i$%$tei+ *$!$siti$+7./ I+ '+$the% stu"), (ii"

e%$1i"'ti$+ %e$%te" t$ e i+*%e'se" i+ ese*i'(() i+ u+*$+t%$((e" "i'eti* $% h)e%&()*'e!i'

'+" '(te%e" (ii" !et'$(is!76/

D'0i"s$+ et al '+'()


61/85

stu") 4e%e the %ese+*e $# th%ee $% !$%e !':$% *$%$+$%) he'%t "ise'se %is> #'*t$%s/3

'+" %'+&i+& et4ee+ '&e .6)e'%s i+ !e+ $% 66)e'%s i+ 4$!e+/ I+ *$+t%'st, 'tie+ts 4h$

4e%e *u%%e+t s!$>e%s/2 '+" 'tie+ts 4ith t%i&()*e%i"es 2/26!!$((J/ 4e%e

(ess (i>e() t$ '*hie0e thei% LDL-C t'%&et2/

S*he*t!'+ et al e0'(u'te" the #'*t$%s th't %est%i*ti+& the LDL-C t'%&et '*hie0e!e+t i+

'tie+ts 4ith *'%"i$0's*u('% "ise'se 4hi*h sh$4e" th't the %e"i*t$%s $# LDL-C '*hie0e!e+t

4e%e ($4e% 'se(i+e LDL-C t%)&()*e%i"es, the use $# *$!i+'ti$+ $# "%u& the%') %'the% th'+

!$+$the%') '+" 'tie+ts '"he%e+*e t$ t%e't!e+t77/ This 4's '+ e1isti+& stu") i+ 997 '+"

the !$%e $te+t st'ti+ su*h 's 't$%0'st'ti+ 4's sti(( +$t '0'i('(e/ I+ $u% stu"), 4e

'"!i+iste%e" ' *%$sse*ti$+'( stu") '+" "i" +$t e0'(u'te the *h'%'*te%isti* $# the 'se(i+e '+"

the 'tie+ts 4e%e $+ !$+$the%') st'ti+ t%e't!e+t/

A+"%e4s et al !'"e ' *$!'%is$+ et4ee+ "i##e%e+t t)es $# st'ti+ i+*(u"i+&

't$%0'st'ti+, si!0'st'ti+, %'0'st'ti+, #(u0'st'ti+ '+" ($0'st'ti+/ The LDL-C (e0e( 4's e(i*ite"

't 'se(i+e '+" '#te% 6. *$+se*uti0e 4ee>s $# t%e't!e+tK the "$se $# e'*h st'ti+ 4's tit%'te"

'**$%"i+&()/ The &%e'test !e'+ %e"u*ti$+ $# LDL-C 4's e(i*ite" '!$+& 'tie+ts $+

't$%0'st'ti+/ The e%*e+t'&e %e"u*ti$+ i+ LDL-C '*hie0e" 't '+ i+iti'( "$se *$%%e('te"

st%$+&() 4ith the %$$%ti$+ $# 'tie+ts 4h$ !'i+t'i+e" thei% &$'(s 't 6. 4ee>s%-/;.78/

I+ $u% stu"), the 'ss$*i'ti$+ et4ee+ the t)e $# st'ti+ use" '+" the LDL-C '*hie0e!e+t 4's

'+'()


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CHAPTER =

CONCLUSIONS

A*hie0e!e+t $# L$4 De+sit) Li$%$tei+ t'%&et i+ T)e 2 Di'etes Me((itus 4ith

")s(ii"'e!i' '!$+& 'tie+ts 4h$ 'tte+"e" @R@,HUSM 4's sti(( ($438/7 e0e+ 4ith the

'0'i('i(it) $# $te+t st'ti+ the%')/ M':$%it) $# the 'tie+ts9;/2 '"he%e" t$ st'ti+ the%')

'+" 2/6 $# the 'tie+ts 4e%e #u(( i+ '"he%e+*e/ H$4e0e%, the%e 4e%e +$ 'ss$*i'ti$+ et4ee+

'"he%e+*e '+" LDL-C '*hie0e!e+t/ I+ this stu"), HA* 4's the $+() si&+i#i*'+t #'*t$%

'ss$*i'te" 4ith +$+'*hie0e!e+t LDL-C t'%&et/

6


63/85

CHAPTER >

LIMITATIONS OF THE STUD8

This stu") h's ee+ "esi&+e" 4ith $u% '%'!$u+t 'i(it) i+ $%"e% t$ &et 0'(i" "'t' '+" %e(i'(e

%esu(ts/ H$4e0e%, si!i('% t$ '+) $the% stu"ies, this stu") is +$t e1e!te" #%$! (i!it'ti$+s 's

$ut(i+e" e($4=

/ The !':$% #'*t$%s th't *'+ i+#(ue+*e *h$(este%$( (e0e( su*h 's "iete%) 'tte%+ '+"

h)si*'( '*ti0it) '%e +$t 'ssesse" i+ this stu")/ This stu") $+() e1($%e" the

s$*i$"e!$&%'hi* '+" *(i+i*'( #'*t$%s/

2/ The "i'&+$sis $# T)e 2 Di'etes Me((itus '+" D)s(ii"'e!i' 4's 'se" $+ se(#

%e$%t/ The%e 4i(( e i'sK %e&'%"(ess i# ' %$e% "i'&+$sis is !'"e '**$%"i+& t$ the

%e(e0'+t &ui"e(i+e/

3/ This stu") "i" +$t e0'(u'te the *$-!$%i"ities '+" $the% %is> #'*t$%s 's ee+ "es*%ie"

i+ %e0i$us stu")/ We $+() ($$>e" i+t$ 'tie+ts 4ith T)e 2 Di'etes Me((itus '+"

D)s(ii"'e!i'/

./ The "'t' %e%ese+ts $+() $+e $ut'tie+t *(i+i* i+ te%ti'%) *e+t%e, i+ste'" $# i+0$(0i+&

$the% $ut'tie+t *(i+i*s i+ $the% te%ti'%) *e+t%e $% $the% %i!'%) he'(th *(i+i* i+ $the%

"ist%i*ts $% st'tes/ The%e#$%e, the %esu(ts $# the stu") '%e +$t %e%ese+t'ti0e $# e+ti%e

$u('ti$+/

6


64/85

6/ The stu") h's (i!it'ti$+ i+ te%! $# its "esi&+ '+" s'!(i+&/ It 4's ' *%$ss-se*ti$+'(

stu") '+" the se(e*ti$+ $# '%ti*i'+ts 4e%e "$+e ) '**$u+ti+& $+() the 'tie+ts 4h$

'tte+"e" the *(i+i* #$% ($$" t'>i+& %$*e"u%e 4hi*h !i&ht (e'" t$ the i's i+ the

%e*%uite!e+t $# the 'tie+ts/

7/ This stu") use" ' se(#-%e$%te" !e'su%e!e+t $# '"he%e+*e 4hi*h !i&ht e $0e% $%

u+"e%%e$%te"/ The%e#$%e, the '*tu'( %$$%ti$+ $# +$+-'"he%e+*e t$ st'ti+ the%') !')

e hi&he% th'+ 4h't 4's %e#(e*te" i+ this stu")/ The %e0ie4s $# !e"i*'( %e*$%" *'+

he( %ese'%*he% 0e%i#ies the i+#$%!'ti$+/ H$4e0e%, e*'use $# ti!e *$+st%'i+t '+"

(i!ite" hu!'+ %es$u%*es, su*h %e0ie4 4$u(" +$t h'0e ee+ $ssi(e/

62


65/85

RECOMMENDATIONS

As "e!$+st%'te" *(e'%() i+ this stu"), the %$$%ti$+ $# LDL-C t'%&et '*hie0e%s '+"

+$+'*hie0e%s '!$+& 'tie+ts 4ith T)e 2 Di'etes Me((itus '+" ")s(ii"'e!i' is sti(( ($4 i+

$u% $u('ti$+ '+" the%e 4's '+ 'ss$*i'ti$+ et4ee+ HA* '+" LDL-C '*hie0e!e+t/

The%e#$%e, ' h$(isti* '+" i+te%&%'te" '%$'*h sh$u(" e i+te+si#ie" i+ t'%&eti+& $u% 'tie+ts

'+" he'(th *'%e %$0i"e%s ese*i'(() i+ the !'+'&e!e+t $# 'tie+ts 4ith *$!$%i" "i'etes

'+" ")s(ii"'e!i'/ A(( 'tie+ts "i'&+$se" 4ith ")s(ii"'e!i' '+" "i'etes sh$u(" e &i0e+ '

%$e% he'(th e"u*'ti$+ '+" '4'%e+ess $+ the i!$%t'+*e $# '*hie0i+& the t'%&et $# the"ise'ses/ These i+#$%!'ti$+ sh$u(" +$t $+() e i+#$%!e" "u%i+& the "i'&+$si+& e%i$" ut

!ust e *$+ti+u$us '+" e%siste+t i+ e0e%) 0isit/

T%'i+i+& the he'(th *'%e %$0i"e%s i+ te%!s $# &$$" %'*ti*e i+ the !'+'&e!e+t $#

")s(ii"'e!i' '+" %'isi+& the '4'%e+ess $# $u% *u%%e+t t%e't!e+t '+" &ui"e(i+es 4$u("

i!%$0e $u% *'%e t$4'%"s these 'tie+ts/ A(( $# these '%$'*hes h'" ee+ *'%%ie" $ut i+ $u%

setti+& ut the) sti(( ('*> sue%0isi$+ '+" 'u"it ese*i'(() i+ the $ut'tie+t *(i+i* i+ te%ti'%)

*e+t%e/ We +ee" t$ "esi&+ ' ette% s)ste! i+ $%"e% t$ !'>e su%e th't $u% 'tie+ts &et ette%

*'%e/ A "e"i*'te" e"u*'ti$+ te'! i+ the *(i+i* is 0e%) e+e#i*i'( ut the ('*> $# hu!'+

%es$u%*es %e+"e%e" the '%$'*h +$+ e%siste+t '+" +$t $ti!i


66/85

REFERE6CES

/ Ah!'" WAW, H'+ S@/ N'ti$+'( C'%"i$0's*u('% Dise'se D't''se= Re$%t $# A*uteC$%$+$%) S)+"%$!e Re&ist%) 27/ 27/

2/ Yusu# S, Re"") S, \u+uu S, A+'+" S/ G($'( u%"e+ $# *'%"i$0's*u('% "ise'ses '%t

I= &e+e%'( *$+si"e%'ti$+s, the ei"e!i$($&i* t%'+siti$+, %is> #'*t$%s, '+" i!'*t $#

u%'+i '+" 4hite

!e+ 4ith "i'etes s*%ee+e" #$% the Mu(ti(e Ris> F'*t$% I+te%0e+ti$+ T%i'( MRFIT/

I+te%+'ti$+'( :$u%+'( $# ei"e!i$($&)/ 99;K28.=737-./

8/ @'++e( WB/ Lii"s, "i'etes, '+" *$%$+'%) he'%t "ise'se= i+si&hts #%$! the

F%'!i+&h'! Stu")/ A!e%i*'+ he'%t :$u%+'(/ 9;6K6=-8/

;/ N'ti$+'( He'(th M$%i"it) Su%0e) 2 F'*t Sheet/ I+= I+stitute $# Pu(i* He'(thIPH

NCD, e"it$%/ 2/

9/ 5$h+ Bette%i"&e D/ D)s(ii"'e!i' '+" "i'etes/ P%'*ti*'( Di'etes I+te%+'ti$+'(/

2K;7=2-8/

/ T's>i+e+ M-R/ Di'eti* ")s(ii"'e!i'= #%$! 'si* %ese'%*h t$ *(i+i*'( %'*ti*e /̂

Di'et$($&i'/ 23K.77=833-.9/

/ W_&+e% AM', 5$%' O, Ri&(' M, B$+et R, "e Lei0' A, O%"`ae


67/85

2/ B($$" *h$(este%$( '+" 0's*u('% !$%t'(it) ) '&e, se1, '+" ($$" %essu%e= ' !et'-

'+'()sis $# i+"i0i"u'( "'t' #%$! 7 %$se*ti0e stu"ies 4ith 66 0's*u('% "e'ths/ The

L'+*et/38972=;29-39/

3/ C(i+i*'( P%'*ti*e Gui"e(i+e .th E"iti$+ M'+'&e!e+t $# D)s(ii"'e!i' 2= Mi+ist%)

O# He'(th, M'(')si'K 2/

./ P'+e( NCEPE/ Dete*ti$+, E0'(u'ti$+ '+" T%e't!e+t $# Hi&h B($$" *h$(este%$( i+

A"u(ts A"u(t T%e't!e+t P'+e( III/ 22 Sete!e% 22/ Re$%t N$/

6/ Buse 5B, Gi+se%& HN, B'>%is GL, C('%> NG, C$st' F, E*>e( R, et '(/ P%i!'%)

%e0e+ti$+ $# *'%"i$0's*u('% "ise'ses i+ e$(e 4ith "i'etes !e((itus ' s*ie+ti#i* st'te!e+t

#%$! the A!e%i*'+ He'%t Ass$*i'ti$+ '+" the A!e%i*'+ Di'etes Ass$*i'ti$+/ Di'etes *'%e/

28K3=72-82/

7/ Bh'tt'*h'%))' O@, Este) EA, Che+& AY/ U"'te $+ the C'+'"i'+ Di'etes

Ass$*i'ti$+ 2; *(i+i*'( %'*ti*e &ui"e(i+es/ C'+'"i'+ F'!i() Ph)si*i'+/ 29K66=39-.3/

8/ Rei+e% b, C't''+$ AL, De B'*>e% G, G%'h'! I, T's>i+e+ M-R, Wi>(u+" O, et '(/

ESCEAS Gui"e(i+es #$% the !'+'&e!e+t $# ")s(ii"'e!i's The T's> F$%*e #$% the

!'+'&e!e+t $# ")s(ii"'e!i's $# the Eu%$e'+ S$*iet) $# C'%"i$($&) ESC '+" the

Eu%$e'+ Athe%$s*(e%$sis S$*iet) EAS/ Eu%$e'+ he'%t :$u%+'(/ 2K32.=879-;;/

;/ St$+e N5, Me%< CNB, S*M F, B(u! FCB, M*B%i"e FP, E*>e( FRH, et '(/ 23

ACCAHA Gui"e(i+e $+ the T%e't!e+t $# B($$" Ch$(este%$( t$ Re"u*e Athe%$s*(e%$ti*

C'%"i$0's*u('% Ris> i+ A"u(ts/ 5$u%+'( $# the A!e%i*'+ C$((e&e $# C'%"i$($&)/ 23/

9/ S'*>s FM, T$+>i+ AM, Shehe%" 5, B%'u+4'(" E, C$e S, H'4>i+s CM, et '(/ E##e*t

$# %'0'st'ti+ $+ *$%$+'%) "ise'se e0e+ts i+ su&%$us "e#i+e" ) *$%$+'%) %is> #'*t$%s the

%$se*ti0e %'0'st'ti+ $$(i+& %$:e*t/ Ci%*u('ti$+/ 2K27=;93-9/

2/ D'0i"s$+ MH, M'>i @C, Pe'%s$+ TA, P'ste%+'> RC, Dee"4'+i' PC, M*@e++e) 5M,

et '(/ Resu(ts $# the N'ti$+'( Ch$(este%$( E"u*'ti$+ NCEP P%$&%'! E0'(u'ti$+ P%$:e*t

Uti(i


68/85


69/85

3./ A%$+s$+ 5@/ C$!(i'+*e, *$+*$%"'+*e, '"he%e+*e/ B%itish :$u%+'( $# *(i+i*'(

h'%!'*$($&)/ 28K73.=3;3-./

36/ Oste%e%& L, B('s*h>e T/ A"he%e+*e t$ !e"i*'ti$+/ Ne4 E+&('+" 5$u%+'( $# Me"i*i+e/

26K3636=.;8-98/

37/ P('"e0'(( M, Wi((i'!s L@, P$tts LA, Di0i+e G, gi H, L'#'t' 5E/ C(i+i*'( $ut*$!es

'+" '"he%e+*e t$ !e"i*'ti$+s !e'su%e" ) *('i!s "'t' i+ 'tie+ts 4ith "i'etes/ Di'etes

*'%e/ 2.K282=2;-6/

38/ H$ PM, B%)s$+ CL, Ru!s#e(" 5S/ Me"i*'ti$+ '"he%e+*e its i!$%t'+*e i+

*'%"i$0's*u('% $ut*$!es/ Ci%*u('ti$+/ 29K923=32;-36/

3;/ C%'!e% 5, Be+e"i*t A, Mus N, @es>i+'s('+ A, @h'+ / The si&+i#i*'+*e $#

*$!(i'+*e '+" e%siste+*e i+ the t%e't!e+t $# "i'etes, h)e%te+si$+ '+" ")s(ii"'e!i'= '

%e0ie4/ I+te%+'ti$+'( :$u%+'( $# *(i+i*'( %'*ti*e/ 2;K72=87-;8/

39/ G%'+t RW, De0it' NG, Si+&e% DE, Mei&s 5B/ P$()h'%!'*) '+" !e"i*'ti$+ '"he%e+*e

i+ 'tie+ts 4ith t)e 2 "i'etes/ Di'etes *'%e/ 23K276=.;-2/

./ A"he%e+*e t$ ($+&-te%! the%'ies= e0i"e+*e #$% '*ti$+ I+te%+et/ W$%(" He'(th

O%&'+i


70/85

.8/ H'ss'+ NB, H's'+'h C, F$$+& @, N'i+& L, A4'+& R, Is!'i( SB, et '(/ I"e+ti#i*'ti$+

$# s)*h$s$*i'( #'*t$%s $# +$+*$!(i'+*e i+ h)e%te+si0e 'tie+ts/ 5$u%+'( $# hu!'+

h)e%te+si$+/ 26K2=23-9/

.;/ M'(')si' MOH/ N'ti$+'( Di'etes Re&ist%) Re$%t 29-22/ I+= Dise'se NC, e"it$%/

22/

.9/ M'#'u(e E, Tu%+e% ST/ Eth+i* '+"

se1 "i##e%e+*es i+ the %e0'(e+*e, t%e't!e+t, '+" *$+t%$( $# ")s(ii"e!i' '!$+& h)e%te+si0e

'"u(ts i+ the GENOA stu")/ A%*hi0es $# i+te%+'( !e"i*i+e/ 2.K7.2=33-;/

68/ B'+t' MR, M' F, B%'0't' DM, @i%s+e% RS, Fe"e%!'+ DG/ I+*i"e+*e $# '+" #'*t$%s'ss$*i'te" 4ith '*hie0i+& t'%&et (ii" (e0e(s i+ 'tie+ts 4ith e%ihe%'( '%te%i'( "ise'se/

5$u%+'( $# &e+e%'( i+te%+'( !e"i*i+e/ 27K28=8-./

6;/ Ni%'+:'+ G, A%u+ M, S%i+i0's'+ A, Muthu%'+&'+ G, S'h' S, R'!'s'!) R/

ASSOCIATION OF LEVELS OF HAC WITH TRIGLYCERIDEHIGH DENSITY

LIPOPROTEIN RATIOAN INDICATOR OF LOW DENSITY LIPOPROTEIN PARTICLE

SIE IN TYPE 2 DIABETES MELLITUS/ Me" I+t/ 22K23=;8-96/

6;


71/85

69/ Vi+$"M'h't$ R, G)'4'(i P, R'ut PP, Re&!i P, Ps" @, Si+&h DRP, et '(/ Ass$*i'ti$+

et4ee+ &()*'e!i* *$+t%$( '+" se%u! (ii" %$#i(e i+ t)e 2 "i'eti* 'tie+ts= G()*'te"

h'e!$&($i+ 's ' "u'( i$!'%>e%/ Bi$!e"i*'( Rese'%*h/ 2K223=386-;/

7/ Si+&h G, @u!'% A/ Re('ti$+shi A!$+& HA* '+" Lii" P%$#i(e i+ Pu+':i T)e 2

Di'eti* P$u('ti$+/ 5$u%+'( $# E1e%*ise S*ie+*e '+" Ph)si$the%')/ 2K82=99-2/

7/ @h'+ HA/ C(i+i*'( si&+i#i*'+*e $# HA* 's ' !'%>e% $# *i%*u('ti+& (ii"s i+ !'(e '+"

#e!'(e t)e 2 "i'eti* 'tie+ts/ A*t' "i'et$($&i*'/ 28K...=93-2/

72/ H'!!e" I@, Ae" BA, R'shi" NF/ G()*'te" h'e!$&($i+ 's ' "u'( i$!'%>e%

Ass$*i'ti$+ et4ee+ HA* '+" ")s(ii"e!i' i+ t)e 2 "i'eti* 'tie+ts/

73/ @h'+ CR, Wei% GC, @i+& &L, 5'*$s$+ AM/ 5$s(i+s Di'etes Me((itus . e"=

Lii+*$tt Wi((i'!s '+" Wi(>i+sK 26/

7./ Pete%s AL/ C(i+i*'( %e(e0'+*e $# +$+-HDL *h$(este%$( i+ 'tie+ts 4ith "i'etes/

C(i+i*'( "i'etes/ 2;K27=3-8/

76/ Su%)'4'+shi N, Bhute) A, N'&"e$te A, 5'"h'0 A, M'+$$%>'% G/ Stu") $# (ii"

e%$1i"e '+" (ii" %$#i(e i+ "i'etes !e((itus/ I+"i'+ 5$u%+'( $# C(i+i*'( Bi$*he!ist%)/

27K2=27-3/

77/ S*he*t!'+ G, Hi'tt 5/ D%u& the%') #$% h)e%*h$(este%$(e!i' i+ 'tie+ts 4ith

*'%"i$0's*u('% "ise'se= F'*t$%s (i!iti+& '*hie0e!e+t $# (ii" &$'(s/ The A!e%i*'+ 5$u%+'( $#

Me"i*i+e/ 997K2=98-2./

78/ A+"%e4s TC, B'(('+t)+e CM, Hsi' 5A, @%'!e% 5H/ A*hie0i+& '+" !'i+t'i+i+&

+'ti$+'( *h$(este%$( e"u*'ti$+ %$&%'! ($4-"e+sit) (i$%$tei+ *h$(este%$( &$'(s 4ith #i0e

st'ti+s/ The A!e%i*'+ 5$u%+'( $# Me"i*i+e/ 2K3=;6-9/

69


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APPENDIXES

7


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A11(#; 7

7


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A11(#; II

72


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A11(#; III

MAKLUMAT KAIAN

Tajuk Kajian! Penca"aian Taha" #olesterol $i"o"rotein %er&etum"atan 'endah, (a&tor-fa&tor yang

mem"engaruhinya dan #etida&"atuhan Terhada" )*at Anti&olesterol +enis Statin alam #alangan

Pesa&it #encing Manis +enis .

N'!' Pe+)e(i"i>= P%$#es$% M'")' D%/ Sh'i#u( B'h'%i Is!'i( NO/ MMC= 3;38 D%/ N'+i D%'!'+ NO/ MMC= 36.;;

D%/ N$%u( B'"%i'h H'ss'+D% 'i+' M't Yu"i+B'"%i+ NO/ MMC= .3

Pe+&e+'('+

A+"' "ie('4' u+tu> !e+)e%t'i s'tu >':i'+ e+)e(i"i>'+ se*'%' su>'%e('/ See(u! !e+)e%t'i >':i'+

i+i, '+"' "i>ehe+"'>i !e!'*' "'+ !e!'h'!i $%'+& i+i/ B$%'+& i+i !e+e%'+&>'+ tu:u'+ >':i'+,

%$se"u%, %isi>$ "'+ !'+#''t >':i'+/ I' :u&' !e+e%'+&>'+ 'h'4' '+"' $(eh !e+'%i> "i%i "'%i'"'

>':i'+ i+i '"' i('-i(' !'s'/ 5i>' '+"' e%setu:u !e+)e%t'i >':i'+ i+i '+"' '>'+ !e+e%i!' s'(i+'+

$%'+& i+i u+tu> si!'+'+ '+"'/

Sehuu+&'+ itu, '+"' "i!i+t' '&'% !e!'*' "'+ !e!'h'!i se&'(' >ete%'+&'+ "i '4'h )'+& '>'+

!e!e%i e+e%'+&'+ ('+:ut !e+&e+'i >':i'+ i+i/

Tu:u'+ @':i'+

@':i'+ i+i "i:'('+>'+ u+tu> !e+&u>u% t'h' (i$%$tei+ e%>etu!'t'+ %e+"'h )'+& "i*''i

"'+ !e+&u>u% t'h' >e'tuh'+ es'>it te%h'"' u't '+ti >$(este%$( :e+is st'ti+ "'('!

>'('+&'+ es'>it @e+*i+& M'+is 5e+is 2/ D'%i'"' >':i'+ i+i :u&', #'>t$%-#'>t$% )'+&

!e!e+&'%uhi (i$%$tei+ e%>etu!'t'+ %e+"'h es'>it "''t "i>':i/ U't >$(este%$( :e+is

st'ti+ te('h te%u>ti >ee%>es'+'++)' u+tu> !e+u%u+>'+ t'h' >$(este%$( "'('! "'%'h )'+&

"i&u+'>'+ u>'+ s'h':' u+tu> %'4't'+ !'s'('h >$(este%$( ti+&&i "'('! "'%'h tet'i :u&'

u+tu> e+*e&'h'+ "'+ %'4't'+ e+)'>it >'%"i$0's>u('%/ @e'tuh'+ es'>it te%h'"'

e+&&u+''+ u't '+ti >$(este%$( :e+is st'ti+ '!'t e+ti+& u+tu> !e!'sti>'+ >ee%>es'++)'/

K).+./. P+4"..

D$>t$% )'+& e%t'+&&u+&:'4' "'('! >':i'+ i+i 't'u s'('h se$%'+& >'>it'+&'+ >':i'+ te('h

!e!i+*'+&>'+ >e(')'>'+ u+tu> !e+)e%t'i >':i'+ i+i "e+&'+ '+"'/ A"'('h e+ti+& '+"' e%te%us

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te%'+& "e+&'+ "$>t$% "'+ >'>it'+&'+ te%seut te+t'+& se:'%'h >esih't'+ '+"'/ A+"' ti"'> seh'%us+)'

!e+)e%t'i >':i'+ i+i se>i%'+)' '+"' ti"'> !e!e+uhi se!u' s)'%'t >e(')'>'+/

Bee%'' >ee%(u'+ u+tu> !e+)e%t'i >':i'+ i+i '"'('h=

@e(')'>'+ Pe+)e%t''+=

/ Be%u!u% ; t'hu+ "'+ >e 't's/

2/ Pes'>it te('h "is'h>'+ !e+&hi"' e+)'>it @e+*i+& M'+is 5e+is 2/

3/ Pes'>it te('h "is'h>'+ !e+&hi"' e+)'>it D)s(ii"'e!i'/

./ D'('! %'4't'+ u't '+ti >$(este%$( :e+is st'ti+ s'h':' se('!' 7 u('+ 't'u (eih/

A+"' ti"'> $(eh !e+)e%t'i >':i'+ i+i se>i%'+)'=

/ A+"' !e!u+)'i e+)'>it !e+t'( 't'u >e%e+*'t'+ $t'>/

2/ A+"' ti"'> t'hu !e!'*' "'+ !e+u(is/

3/ T'h' t%i&()*e%i"e ./3!!$((

P%$se"u%-%$se"u% @':i'+

Se(e's '+"' !e!e%i e%setu:u'+ e%tu(is u+tu> !e+:'('+i >':i'+ i+i '+"' '>'+ "i!i+t' u+tu>

!e+&isi $%'+& s$'(-se(i"i> !e+&e+'i "'t' e%i'"i se%t' !e+:'4' s$'('+ !e+&e+'i t'h' >e'tuh'+

te%h'"' u't '+ti>$(este%$( :e+is st'ti+/

5i>' '+"' !e!u+)'i se'%'+& >e!us)>i('+ 't'u ti"'> !e!'h'!i !'+'-!'+' 'h'&i'+ "i "'('!

s$'(-se(i"i> te%seut, '+"' $(eh('h !e%u:u> !'s'('h te%seut >e'"' e+)e(i"i> )'+& '>'+ se+ti's'

e%'"' "i situ '&i !e!'+tu '+"'/

Risi>$

Ti'"' se'%'+& %isi>$ )'+& '>'+ "it'+&&u+& $(eh '+"' :i>' '+"' !e+)e%t'i >':i'+ i+i/

F'e"'h

H'si( >':i'+ i+i '"'('h e+ti+& "'('! !e+i+&>'t>'+ >ese"'%'+ "i >'('+&'+ es'>it >e+*i+& !'+is "'+

h)e%(ii"'e!i' te+t'+& >ee+ti+&'+ >e'tuh'+ te%h'"' u't '+ti>$(este%$(/

7.


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Pe+)e%t''+ D'('! @':i'+

Pe+)e%t''+ '+"' "'('! >':i'+ i+i '"'('h se*'%' su>'%e('/ A+"' $(eh !e+$('> u+tu> !e+)e%t'i >':i'+

i+i 't'u '+"' $(eh !e+'!'t>'+ e+)e%t''+ '+"' '"' i('-i(' !'s', t'+' se'%'+& hu>u!'+ 't'u

>ehi('+&'+ !'+#''t )'+& se'tut+)' '+"' e%$(ehi/

S$'('+

Se>i%'+)' '+"' !e!u+)'i se'%'+& s$'('+ !e+&e+'i >':i'+ i+i 't'u h'>-h'> '+"', si(' huu+&i

D% 'i+' M't Yu"i+B'"%i+,5''t'+ Pe%u't'+ @e(u'%&' ,@'!us Pe%u't'+ USM,76 @u'+& @e%i'+ @e('+t'+ +$ te( = 87;2298.Se>i%'+)' '+"' !e!u+)'i se'%'+& s$'('+ e%>'it'+ >e(u(us'+ Eti>' >':i'+ i+i, si(' huu+&iK

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