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Asymptomatic coronary heart disease in patients with type 2 diabetes with vascular complications: a cross-sectional
Tetsuro Tsujimoto1, Hiroshi Kajio, Yoshihiko Takahashi
1Department of Diabetes and Metabolic Medicine and Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan.
Insights
Many patients with type 2 diabetes and vascular complications have undiagnosed coronary heart disease (CHD). This study found over half had asymptomatic CHD, highlighting the need for screening in this high-risk group.
Area of Science:
- Cardiology
- Endocrinology
- Vascular Medicine
Background:
- Microvascular and macrovascular diseases are linked to coronary events.
- Diabetes mellitus is a significant risk factor for cardiovascular complications.
- Vascular complications in diabetes may indicate underlying coronary artery disease.
Purpose of the Study:
- To determine the prevalence of asymptomatic coronary heart disease (CHD) in patients with type 2 diabetes and vascular complications.
- To investigate the association between vascular complications and undiagnosed CHD.
- To identify risk factors for asymptomatic CHD in this population.
Main Methods:
- A cross-sectional study was conducted at a national diabetes center in Japan.
- 122 patients with type 2 diabetes and vascular complications (retinopathy, nephropathy, peripheral arterial disease, or cerebrovascular disease) were enrolled.
- Stress single-photon emission computed tomography (SPECT) and coronary angiography were used to assess for CHD.
Main Results:
- 79% of patients exhibited myocardial perfusion abnormalities on SPECT.
- 53% of patients had asymptomatic coronary heart disease with ≥50% diameter stenosis.
- Male sex was the only significant predictor of asymptomatic CHD (OR 6.18).
Conclusions:
- Asymptomatic coronary heart disease is highly prevalent in patients with type 2 diabetes and vascular complications.
- Myocardial perfusion abnormalities and significant coronary stenosis were common findings.
- Routine screening for CHD should be considered in diabetic patients with existing vascular disease.
Background:
Recent studies have suggested that microvascular and macrovascular diseases are associated with coronary events.
Objective:
To test the hypothesis that asymptomatic coronary heart disease (CHD) may be present in many patients with diabetes with vascular complications.
Design:
From April 2009 to August 2010, the authors conducted a cross-sectional study to assess the prevalence of asymptomatic CHD among patients with type 2 diabetes with vascular complications at a national diabetes centre in Japan. Eligibility criteria included patients with type 2 diabetes with no known CHD and one or more of the following four criteria: (1) proliferative diabetic retinopathy or after photocoagulation; (2) estimated glomerular filtration rate <30 ml/min/1.73 m² or an estimated glomerular filtration rate <45 ml/min/1.73 m² plus albuminuria; (3) peripheral arterial disease; and (4) cerebrovascular disease. Each patient underwent a stress single-photon emission computed tomography; patients with myocardial perfusion abnormalities then underwent coronary angiography.
Results:
A total of 1008 patients with type 2 diabetes were screened, and 122 eligible patients consented to participate. Stress single-photon emission computed tomography revealed myocardial perfusion abnormalities in 96 (79%) patients. Of the 112 patients who completed the study protocol, 59 (53%) had asymptomatic CHD with ≥50% diameter stenosis. Additionally, 35 (31%) patients had multivessel disease or left main disease, and 42 (38%) had a coronary artery with ≥75% diameter stenosis. In the multivariate logistic-regression analysis to identify coronary risk factors associated with asymptomatic CHD, the only significant predictor was male sex (OR 6.18; 95% CI 2.30 to 16.64; p<0.001).
Conclusions:
Asymptomatic CHD with ≥50% diameter stenosis and myocardial perfusion abnormalities was detected in more than half of the patients with type 2 diabetes with vascular complications.
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