Abstract
People with diabetes mellitus have a 2–8-fold excess in cardiovascular mortality than people without diabetes. This study compared angiographically determined cardiovascular disease in 79 patients with diabetes mellitus and an equal number of matched controls without diabetes under the age of 55 years. Seventy-nine diabetic patients coming to coronary angiography during a 12-month period were reviewed retrospectively along with 79 control patients matched for age (±3 years), sex, ethnic origin and risk factors (hyperlipidemia, body mass index and smoking history). The angiographic features of a consecutive series of 62 European and 17 Asian patients and their matched-paired controls were assessed. In all study subjects had undergone elective coronary angiography and ventriculography. Angiographic findings were graded to describe severity and extent of coronary atherosclerosis. Left ventricular systolic function was assessed by ejection fraction. The diabetic group had a significantly higher arterial systolic pressure than the non-diabetic group (p < 0.008) and they were clinically obese with a body mass index of >30. Detailed analysis of the angiograms showed that prevalence and severity of coronary artery disease in diabetic patients was greater. The mean ‘severity score’ was 11.66 for the diabetic group against 8.49 for the non-diabetic group (p < 0.037). Multivessel disease was more common in diabetic patients than in the controls, with three-vessel disease being the most common. Furthermore, 38 of 79 diabetic patients had three-vessel disease compared to 29 of 79 controls. Diabetic patients were also more likely to have more segments diseased in one vessel. Systolic function was reduced in the diabetic group, with a significantly lower (p < 0.05) mean ejection fraction. The present study supports the evidence that diabetic patients have more extensive coronary artery disease than non-diabetic patients and a poorer prognosis, and that the coronary arteries of the Asian patients were affected more adversely than those of the European group irrespective of the diabetic state. (Mol Cell Biochem 261: 263–269, 2004)
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References
Grundy SM, Benjamin IJ, Burke GL, Eckel RH, Howard BV, Mitch W, Smith SC, Sowers JR: Diabetes and cardiovascular disease a statement for healthcare professionals from the American Heart Association. Circulation 100: 1134–1146, 1999
Clark CM, Clark PR: Type 2 diabetes and macrovascular disease. Epidemiology and etiology. Am Heart J 138: 5330–5333, 1999
Kannel WB, McGee DL: Diabetes and cardiovascular disease. The Framingham Study. JAMA 241: 2035–2039, 1979
Dash H, Johnson RA, Dinsmore RE, Francis CK, Harthorne W: Cardiomyopathic syndrome due to coronary artery disease. II. Increased prevalence in patients with diabetes mellitus: A matched pair analysis. Br Heart J 39: 740–747, 1997
Amos AF, McCarty DJ, Zimmet P: The rising global burden of diabetes and its complications: Estimates and projections to the year 2010. Diabetes Med 14: S7–S15, 1997
Fein FS, Sonnenblick EH: Diabetic cardiomyopathy. Cardiovasc Drugs Ther 8: 65–73, 1994
Chugh A, Eagle KA, Mehta RH: Cardiac complications and management. In: R. Williams, A.L. Kinmonth, N.J. Wareham (eds). The Evidence Base for Diabetes Care. Wiley, London, 2002, pp 577–590
Khaleeli E, Peters SR, Bobrowsky K, Oudiz RJ, Ko JY, Budoff MJ: Diabetes and the associated incidence of subclinical atherosclerosis and coronary artery disease: Implications for management. Am Heart J 141: 637–642, 2001
Silva JA, Escobar A, Collins TJ, Ramee SR, White C: A comparison of angioscopic findings between diabetic and nondiabetic patients. Circulation 92: 1731–1735, 1995
Krishnaswami S, Joseph G, Punnoose E, Chandy ST: Coronary angiographic findings in patients with diabetes: An exercise in cardiovascular epidemiology. JAPI 44: 169–171, 1996
Bracken NK, Singh J, Winlow W, Howarth FC. Mechanisms underlying contractile dysfunction in streptozotocin-induced type 1 and type 2 diabetic cardiomyopathy. In: G.N. Pierce, M. Nagano, P. Zahradka, N.S. Dhalla (eds). Atherosclerosis, Hypertension and Diabetes. Kluwer, Boston, 2003, pp 387–408
Shapiro LM, Howat AP, Calter MM: Left ventricular function in diabetes mellitus. 1. Methodology, and prevalence and spectrum of abnormalities. Br Heart J 45: 122–128, 1981
Dhawan J, Bray CL: Angiographic comparison of coronary artery disease between Asians and Caucasians. Postgrad Med J 70(suppl 827): 625–630, 1994
Viswanathan V, Chamukuttan S, Rangamoorthy SM, Nair BM, Ramachandran A: Increased carotid intimal media thickness preceded albuminuria in south Indian type 2 diabetic subjects. Br J Diabetes Vasc Dis 3: 146–149, 2003
hhtp://bhf.org.uk
Wittels EH, Grotto AM: Clinical features of ischaemic heart disease in diabetes mellitus. In: Textbook of Diabetes. Blackwell, London, 1992, Ch 65, pp 1493
Ryden L, Malmberg KA: Reducing the impact of the diabetic heart's vulnerability to cardiovascular disease. Dialog Cardiovasc Med 5: 5–20, 2000
Schneider DJ, Sobel BE: Plaque vulnerability and acute coronary syndromes: What are the prophylactic and therapeutic implications? In: D. de Bono, B.E. Sobel (eds). Challenges in Acute Coronary Syndromes. Blackwell, London, 2001, pp 18–39
Oxford Collaborators: Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360: 1903–1913, 2002
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Fallow, G., Singh, J. The prevalence, type and severity of cardiovascular disease in diabetic and non-diabetic patients: A matched-paired retrospective analysis using coronary angiography as the diagnostic tool. Mol Cell Biochem 261, 263–269 (2004). https://doi.org/10.1023/B:MCBI.0000028764.01670.30
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DOI: https://doi.org/10.1023/B:MCBI.0000028764.01670.30