Peculiarities of clinical and metabolic profile of patients with coronary artery disease associated with type 2 diabetes mellitus (retrospective analysis)
DOI:
https://doi.org/10.14739/2310-1237.2020.2.212754Keywords:
coronary artery disease, type 2 diabetes mellitus, obesity, hypercholesterolemia, remodelingAbstract
Coronary artery disease (CAD) is one of the most common reasons of disability and mortality. Diabetes mellitus occurs in 30% of patients with IHD and aggravates the course of the underlying disease, worsens the prognosis and quality of life. However, the clinical features of this comorbidity are not fully understood.
Aim of the study: to determine the effect of type 2 diabetes mellitus on the clinical and metabolic features of patients with coronary artery disease.
Materials and methods. Retrospective analysis of 256 medical records of inpatients with CAD (males – 106, females – 150, age – 66 (59; 71) years) was performed. The patients were divided into two groups: Group 1 (main) – 213 patients with CAD with type 2 DM; Group 2 (comparison) – 43 patients with isolated CAD. Statistical processing was carried out using Statistica 13.0 software package.
Results. It was found that the course of CAD in diabetic patients is associated with higher frequency of cardiovascular complications (arrhythmias, atherothrombotic events). It has been found, that in patients with CAD associated with type 2 DM, body mass index (by 9.39 %), levels of systolic (by 9.28%) and diastolic (by 9.09 %) blood pressure, glucose (by 53.92 %), glycated hemoglobin (by 45.81 %), total cholesterol (by 11.13 %), triglycerides (by 18.86 %) exceeded the corresponding indicators in patients with isolated CAD (P < 0.05). Multicomponent metabolic syndrome was reported in 89 % of patients with type 2 DM. In patients with CAD, associated with type 2 DM, if compared to CAD patients without DM, the ejection fraction of the left ventricle (EF LV) was significantly lower by 15.22 %, and the mean pulmonary artery pressure (mPAP) was significantly higher by 29.41 %. The frequency of LV systolic dysfunction (χ2 = 2.75; df = 1; P < 0.05) and an increase of mPAP (χ2 = 2.87; df = 1; P < 0.05) in patients with CAD and type 2 DM was also significantly higher. The calculation of the relative risk allowed to establish the interrelationship between type 2 DM with the risk of developing of LV systolic dysfunction (RR = 2.238; CI 1.322–3.788; P < 0.05) and increased mPAP (RR = 3.337; CI 1.293–8.615; P < 0.05). Concentric left ventricular hypertrophy (77 %) was predominant in patients with CAD and type 2 DM, and in patients with isolated coronary heart disease a concentric LV remodeling (69 %) was dominating.
Conclusions. Concomitant diabetes mellitus affects negatively the course of CAD by increasing the frequency of arrhythmias and atherothrombotic events. In patients with CAD and type 2 DM a multicomponent metabolic syndrome prevails, that is characterized by proatherogenic changes in the lipid profile, higher degree of hypertension and obesity. The intensity of cardiac remodeling in patients with CAD was higher in the presence of type 2 DM, which is confirmed by the formation of a prognostically unfavorable type of LV remodeling on the background of the LV systolic function decrease and significant mPAP increase.
References
Kovalenko, V. M. & Bortkevych, O. P. (2019). Komorbidnist: vyznachennia, mozhlyvi napriamky diahnostyky ta likyvannia [Comorbidity: definitions, possible directions of diagnosis and treatment]. Ukrainskyi revmatolohichnyi zhurnal, (3), 33-45. [in Ukrainian].
Mykhailovska, N. S., & Miniailenko, L. Ye. (2017). The state of vascular endothelium, clinical and metabolic features of patients with coronary heart disease combined with nonalcoholic fatty liver disease. Pathologia, 14(1), 62-67 https://doi.org/10.14739/2310-1237.2017.1.97505
Mykhailovska, N., & Kulynych, T. (2017). The influence of community-acquired pneumonia on the clinical course of coronary heart disease: the results of retrospective analysis. Sciencerise: Medical Science, (11), 52-56. https://doi.org/10.15587/2519-4798.2017.116826
Mykhailovska, N. S., Oliinyk, T. V., & Mykhailovskyi, Y. M. (2015). Kliniko-patohenetychna rol imunozapalnykh protsesiv ta endotelialnoi dysfunktsii u khvorykh na ishemichnu khvorobu sertsia komorbidnu z hipoteriozom [Clinical and pathogenetic role of immunoinflammatory disorders and endothelial dysfunction in patients with ischemic heart disease comorbid with hypothyroidism (reference review)]. Bukovinian Medical Herald, 19(1), 227-231. [in Ukrainian].
Tsytovskyi, M. N. (2017). Statystychnyi klinichnyi ta morfolohichnyi aspekty vplyvu tsukrovoho diabetu na stan sertsevo-sudynnoi systemy [Statistical, clinical and morphological aspects of impact of diabetes on the cardiovascular system]. Naukovyi visnyk Uzhhorodskoho universytetu. Seriia : Medytsyna, (1), 168-177. [in Ukrainian].
Abdul-Ghani, M., DeFronzo, R. A., Del Prato, S., Chilton, R., Singh, R., & Ryder, R. E. J. (2017). Cardiovascular Disease and Type 2 Diabetes: Has the Dawn of a New Era Arrived? Diabetes Care, 40(7), 813-820. https://doi.org/10.2337/dc16-2736
Pankiv, V. I. (2017). Porushennia vuhlevodnoho obminu v klinichnii praktytsi [Disorders of carbohydrate metabolism in clinical practice]. International Journal of Endocrinology, 13(1), 39-44. [in Ukrainian].
Huxley, R., Barzi, F., & Woodward, M. (2006). Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ-British Medical Journal, 332(7533), 73-76. https://doi.org/10.1136/bmj.38678.389583.7C
Himion, L. V., Yaschenko, O. B., Vataga, V. V., & Dubchak, A. G. (2016). Faktory ryzyku ishemichnoi khvoroby sertsia ta rozvytok hostroho koronarnoho syndromu v osib z normalnymy pokaznykamy lipidnoho obminu [Risk factors for coronary heart disease and the development of acute coronary syndrome in individuals with normal lipid metabolism]. Semeinaya meditsina, (2), 95-98. [in Ukrainian].
Cosentino, F., Grant, P. J., Aboyans, V., Bailey, C. J., Ceriello, A., Delgado, V., Federici, M., Filippatos, G., Grobbee, D. E., Hansen, T. B., Huikuri, H. V., Johansson, I., Jüni, P., Lettino, M., Marx, N., Mellbin, L. G., Östgren, C. J., Rocca, B., Roffi, M., Sattar, N., … ESC Scientific Document Group (2020). 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. European heart journal, 41(2), 255-323. https://doi.org/10.1093/eurheartj/ehz486
Reges, O., Leibowitz, M., Hoshen, M., Leventer-Roberts, M., Greenland, P., & Balicer, R. (2017). Diabetes control: Incidence of acute myocardial infarction and all-cause mortality among patients with 3-6 years' disease duration. European journal of preventive cardiology, 24(10), 1083–1092. https://doi.org/10.1177/2047487317702041
Einarson, T. R., Acs, A., Ludwig, C., & Panton, U. H. (2018). Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovascular diabetology, 17(1), 83. https://doi.org/10.1186/s12933-018-0728-6
Saklayen, M. G. (2018). The Global Epidemic of the Metabolic Syndrome. Current Hypertension Reports, 20(2), 12. https://doi.org/10.1007/s11906-018-0812-z
Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F. A., Foster, E., Goldstein, S. A., Kuznetsova, T., Lancellotti, P., Muraru, D., Picard, M. H., Rietzschel, E. R., Rudski, L., Spencer, K. T., Tsang, W., & Voigt, J. U. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), 1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003
Pellicori, P., Shah, P., Cuthbert, J., Urbinati, A., Zhang, J., Kallvikbacka-Bennett, A., Clark, A. L., & Cleland, J. (2019). Prevalence, pattern and clinical relevance of ultrasound indices of congestion in outpatients with heart failure. European journal of heart failure, 21(7), 904-916. https://doi.org/10.1002/ejhf.1383
Marwick, T. H., Gillebert, T. C., Aurigemma, G., Chirinos, J., Derumeaux, G., Galderisi, M., Gottdiener, J., Haluska, B., Ofili, E., Segers, P., Senior, R., Tapp, R. J., & Zamorano, J. L. (2015). Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). Journal of the American Society of Echocardiography, 28(7), 727-754. https://doi.org/10.1016/j.echo.2015.05.002
Williams, B., Mancia, G., Spiering, W., Rosei, E. A., Azizi, M., Burnier, M., & European Soc, H. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. European Heart Journal, 39(33), 3021-3104. https://doi.org/10.1093/eurheartj/ehy339
Nagueh, S. F., Smiseth, O. A., Appleton, C. P., Byrd, B. F., Dokainish, H., Edvardsen, T., Flachskampf, F. A., Gillebert, T. C., Klein, A. L., Lancellotti, P., Marino, P., Oh, J. K., Popescu, B. A., Waggoner, A. D., Amer Soc, E., & European Assoc Cardiovasc, I. (2016). Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal-Cardiovascular Imaging, 17(12), 1321-1360. https://doi.org/10.1093/ehjci/jew082
Rodynskyi, O., Basysta, K., & Guz, L. (2018). Neirokhimichni ta povedinkovi protsesy v herontohenezi za umov eksperementalnoi hiperhlikemii [Neurochemical and behavioral processes in gerontogenesis in conditions of experimental hyperglycemia]. Medical Perspectives-Medicni Perspektivi, 23(2), 4-13. https://doi.org/10.26641/2307-0404.2018.2.133691
Syvolap, V. D., & Kapshytar, N. I. (2019). Kardial'noe remodelirovanie v ostrom periode Q-infarkta miokarda, oslozhnennogo ostroi serdechnoi nedostatochnost'yu na fone giperglikemii [Cardiac remodeling in the acute period of Q-myocardial infarction complicated by acute heart failure against hyperglycemia]. Patologia, 16(1), 45-52. [in Russian]. https://doi.org/10.14739/2310-1237.2019.1.166236
Petrova, E. B., Shkrebneva, E. I., Statkevich, T. V., Kartun, L. V., & Mitkovskaya, N. P. (2019). Abdominal obesity and postinfarction cardiosclerosis: cardiometabolic continuum in the development of chronic heart failure. Emergency cardiology and cardiovascular risks, 3(1), 507-512.
Dolzhenko, M. M., Perepelchenko, N. A., Bazylevych, A. Ya. (2010). Ishemichna khvoroba sertsia na tli tsukrovoho diabetu typu 2: osoblyvosti perebihu ta obgruntuvannia terapii [Coronary heart disease on the background of type 2 diabetes: features of the course and rationale for therapy]. Kyiv : Medknyha. [in Ukrainian].
Yang, C. D., Shen, Y., Lu, L., Ding, F. H., Yang, Z. K., Zhang, R. Y., Shen, W. F., Jin, W., & Wang, X. Q. (2019). Insulin resistance and dysglycemia are associated with left ventricular remodeling after myocardial infarction in non-diabetic patients. Cardiovascular Diabetology, 18(1), Article 100. https://doi.org/10.1186/s12933-019-0904-3
Bilchenko, O. V., Lipakova, K. Y., Rudenko, T. A., Vysotska, О. V., Porvan, A. P., & Karami Saliba, D. Y. (2020). Evaluation of heart failure with preserved ejection fraction in patients with coronary heart disease and type 2 diabetes mellitus. Problemy Endocrynnoi Patologii, 1, 7-13. https://doi.org/10.21856/j-PEP.2020.1.01
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