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Atherosclerosis in diabetes and hypertension. A comparative morphometric study of their progression using an
J E Fernández-Britto1, J Bacallao, J A Castillo
1Department of Pathology, Faculty of Medicine Finlay-Albarran, Hospital Dr. C. J. Finlay, Havana, Cuba.
Insights
Diabetes and hypertension significantly accelerate atherosclerosis in coronary arteries. The duration of these conditions independently impacts disease progression, with diabetes showing a stronger effect on severe plaques and hypertension on fibrous plaques.
Area of Science:
- Cardiovascular Pathology
- Atherosclerosis Research
- Medical Autopsy Studies
Background:
- Atherosclerosis is a major cause of cardiovascular disease.
- Diabetes and hypertension are known risk factors for atherosclerosis.
- Understanding their independent and combined effects is crucial for disease management.
Purpose of the Study:
- To investigate the impact of diabetes and hypertension on the progression of atherosclerosis in epicardial coronary arteries.
- To analyze the relationship between disease duration and atherosclerotic lesion severity.
- To determine the interaction effects of diabetes and hypertension on atherosclerotic lesion development.
Main Methods:
- Analysis of 472 autopsy cases categorized into four groups: non-diabetic/non-hypertensive, hypertensive, diabetic, and hypertensive-diabetic.
- Utilized classical pathomorphological procedures and an atherometric system (AS) to characterize atherosclerotic lesions.
- Employed automated data processing and statistical analyses including ANOVA, MANOVA, and principal components analysis.
Main Results:
- Both diabetes and hypertension significantly accelerate atherosclerosis.
- Disease duration positively correlates with atherosclerotic progression, independent of age.
- Diabetes predominantly affects severe plaques (Z), while hypertension impacts fibrous plaques (Y); effects appear additive rather than synergistic.
Conclusions:
- Diabetes and hypertension are independent contributors to accelerated coronary atherosclerosis.
- The duration of diabetes and hypertension influences the rate of atherosclerotic lesion development.
- Distinct plaque types are associated with each risk factor, suggesting additive impacts on cardiovascular disease progression.
Abstract:
The three major epicardial coronary arteries of a set of 472 autopsy cases divided into four groups: a) non-diabetics and non-hypertensive, 322 subjects; b) hypertensive, 75 subjects; c) diabetics, 57 subjects and d) hypertensive and diabetic, 17 subjects, were studied. Classical pathomorphological procedures and an atherometric system (AS), suitable to characterize the atherosclerotic lesions, was used searching for differences between the level of atherosclerosis into these four groups and its eventual progression according to the time of evolution of these diseases. Raw data processing was full automated and some univariate and multivariate statistical procedures (means, standard deviations, ANOVA, MANOVA and principal components analysis) were performed using two commercial statistical packages: "NCSS" and "SYSTAT". The most remarkable findings were the following: Diabetes and hypertension have both strong impact upon the rate at which the atherosclerotic process takes place in subjects affected by these diseases. The time of evolution of both diseases correlates positively and independently of age with the velocity of the atherosclerotic process at the three coronary arteries. The impact of diabetes seems to be stronger and is particularly expressed by the severe plaques (Z) while the effect of hypertension is specially observable at the fibrous plaques (Y). There seems to be no significant interaction (synergism) between the two risk factors upon the measurement of the atherosclerotic lesions, that is, they have an additive effect. Two simple underlying factors can be used to account for interindividual differences. These two factors are "dominated", respectively, by fibrous (Y) and severe plaques (Z).