Publications and Research
Document Type
Article
Publication Date
Spring 2-16-2023
Abstract
Background: Turkish immigrants form the largest ethnic minority group in the
Netherlands and show a higher prevalence of (i) cardiovascular disease (CVD),
(ii) cigarette smoking, and (iii) type 2 diabetes (T2D) as compared to the native
Dutch. This study examines the association of CVD risk factors: serum cotinine, as
an indicator of cigarette smoke, and lipid-related indices among first-generation
(foreign-born) Turkish immigrants with T2D living in deprived neighbourhoods in the
Netherlands.
Methods: A total of 110 participants, physician-diagnosed with T2D, aged 30 years
and older, were recruited by convenience sampling from the Schilderswijk
neighbourhood of The Hague in a clinic-based cross-sectional design. Serum
cotinine (independent variable) was measured with a solid-phase competitive
chemiluminescent immunoassay. Serum lipids/lipoproteins (dependent variables)
were determined by enzymatic assays and included: total cholesterol (CHOL), highdensity
lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c),
and triglycerides (TG). The Castelli Risk Index-I (CRI-I), and Atherogenic Coefficient
(AC) were calculated using standardised formulas and assessed as dependent
variables in multiple linear regression (MLR) models. Log-transformation of HDL-c,
TG, CRI-I, and AC values were performed to account for the extreme right skewness
of the data. Statistical analyses included descriptive characteristics and MLR models
were adjusted for all major confounders of cotinine and lipids.
Results: The sample size had a mean age of 52.5 years [standard deviation
(SD) = 9.21]. The geometric mean of serum cotinine level was 236.63 ng/mL
[confidence interval (CI) = 175.89 ± 318.36]. The MLR models indicated that high
serum cotinine levels (!10 ng/mL) was positively associated with HDL-c (P = 0.04),
CRI-I (P = 0.03), and AC (P = 0.03) in the age, gender, WC, diabetes medications, and
statins-adjusted models (n = 32).
Conclusion: This study indicated that lipid ratios of HDL-c, CRI-I and AC
are dependent determinants of serum cotinine and higher serum cotinine
levels (!10 ng/mL) are associated with worse HDL-c, CRI-I and AC values in
participants with T2D. Clinical comprehension of these biochemical indicators
(lipids/lipoproteins) and symptomatic results (CVD risk) in individuals with T2D
will aid in the intervention (smoking) approach for this vulnerable cohort (Turkish
immigrants). Therapy that is targetted to modify this behavioural risk factor may
improve cardiovascular health outcomes and prevent comorbidities in Turkish
immigrants with T2D living in deprived neighbourhoods in the Netherlands. In the
meantime, this report contributes to a growing body of information and provides
essential guidance to researchers and clinicians.