Lack of correlation between the optimal glycaemic control and coronary micro vascular dysfunction in patients with
Luis Felipe Valenzuela-Garcia1, Yasushi Matsuzawa2, Jaskanwal D S Sara3
1Heart Center, Virgen Macarena Hospital, Avenida Doctor Fedriani, nº 3, 41007, Seville, Spain. lfvgmjrh1@yahoo.es.
Insights
Glycaemic control targets do not predict coronary microvascular function in type 2 diabetes mellitus (T2DM). Age, female gender, and glomerular filtration predict CMD, indicating a need for new prevention strategies for T2DM patients.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Coronary microvascular dysfunction (CMD) is linked to cardiovascular events in type 2 diabetes mellitus (T2DM).
- Achieving optimal glycaemic control (HbA1c < 7%) does not always prevent future cardiovascular events in T2DM patients.
- The study investigates the impact of current HbA1c targets on coronary microcirculatory function and identifies predictors of CMD in T2DM.
Purpose of the Study:
- To assess the effect of the current HbA1c target on coronary microcirculatory function in T2DM patients.
- To identify predictive factors for coronary microvascular dysfunction (CMD) in T2DM patients.
Main Methods:
- 100 T2DM patients and 214 controls with chest pain and non-obstructive coronary artery disease were studied.
- Coronary blood flow was assessed using adenosine and acetylcholine infusions to evaluate endothelial-independent and -dependent function.
- T2DM patients were categorized by HbA1c levels: optimal (<7%) vs. suboptimal (≥7%) at catheterization.
Main Results:
- Prevalence of endothelial-independent and -dependent CMD was similar between optimal and suboptimal glycaemic control groups.
- Age and female gender predicted endothelial-independent CMD; glomerular filtration predicted endothelial-dependent CMD.
- Optimal glycaemic control did not significantly associate with either type of CMD.
Conclusions:
- Current HbA1c targets do not predict improved coronary microcirculatory function in T2DM patients.
- Predictive factors for CMD in T2DM include age, female gender, and glomerular filtration rate.
- Effective strategies for preventing CMD in T2DM patients require further investigation.
Background:
Coronary microvascular dysfunction (CMD) is associated with cardiovascular events in type 2 diabetes mellitus (T2DM). Optimal glycaemic control does not always preclude future events. We sought to assess the effect of the current target of HBA1c level on the coronary microcirculatory function and identify predictive factors for CMD in T2DM patients.
Methods:
We studied 100 patients with T2DM and 214 patients without T2DM. All of them with a history of chest pain, non-obstructive angiograms and a direct assessment of coronary blood flow increase in response to adenosine and acetylcholine coronary infusion, for evaluation of endothelial independent and dependent CMD. Patients with T2DM were categorized as having optimal (HbA1c < 7%) vs. suboptimal (HbA1c ≥ 7%) glycaemic control at the time of catheterization.
Results:
Baseline characteristics and coronary endothelial function parameters differed significantly between T2DM patients and control group. The prevalence of endothelial independent CMD (29.8 vs. 39.6%, p = 0.40) and dependent CMD (61.7 vs. 62.2%, p = 1.00) were similar in patients with optimal vs. suboptimal glycaemic control. Age (OR 1.10; CI 95% 1.04-1.18; p < 0.001) and female gender (OR 3.87; CI 95% 1.45-11.4; p < 0.01) were significantly associated with endothelial independent CMD whereas glomerular filtrate (OR 0.97; CI 95% 0.95-0.99; p < 0.05) was significantly associated with endothelial dependent CMD. The optimal glycaemic control was not associated with endothelial independent (OR 0.60, CI 95% 0.23-1.46; p 0.26) or dependent CMD (OR 0.99, CI 95% 0.43-2.24; p = 0.98).
Conclusions:
The current target of HBA1c level does not predict a better coronary microcirculatory function in T2DM patients. The appropriate strategy for prevention of CMD in T2DM patients remains to be addressed.
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