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Coronary artery disease in type-2 diabetes mellitus: a scintigraphic study
D Giugliano1, R Acampora, N De Rosa
1Department of Gerontology, Geriatrics and Metabolic Disease, Faculty of Medicine, Second University of Naples, Italy.
Insights
This study found that higher cholesterol, white blood cell counts, and microalbuminuria are linked to coronary artery disease in Type 2 diabetes patients. These metabolic control factors are key indicators for cardiovascular risk in this population.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Type 2 diabetes mellitus is a significant risk factor for cardiovascular disease.
- Coronary artery disease (CAD) is a common complication in diabetic patients.
- Evaluating metabolic control and cardiovascular risk factors is crucial for managing Type 2 diabetes with CAD.
Purpose of the Study:
- To assess metabolic control and cardiovascular risk factors in Type 2 diabetic patients with diagnosed coronary artery disease.
- To identify specific risk factors associated with coronary perfusion defects in this patient cohort.
Main Methods:
- Utilized myocardial thallium-201 scintigraphy with exercise stress testing to evaluate coronary perfusion integrity.
- Assessed 146 diabetic patients presenting with symptoms suggestive of CAD.
- Analyzed various cardiovascular risk factors including demographics, anthropometrics, blood pressure, lipids, glycated hemoglobin A1, urinary albumin, white blood cell count, and diabetes duration.
Main Results:
- A higher proportion of male diabetic subjects (63%) showed positive scintigraphy compared to females (45%).
- Patients with positive scintigraphy had a significantly higher prevalence of microalbuminuria (26%) and retinopathy (27%) compared to those with negative scintigraphy (10% and 11%).
- Elevated total cholesterol and white blood cell counts were observed in diabetic patients with positive scintigraphy.
Conclusions:
- Microalbuminuria, elevated cholesterol, and increased white blood cell count are associated with coronary artery disease in Type 2 diabetes.
- These findings highlight a cluster of modifiable risk factors implicated in CAD development among diabetic patients.
- Further research into managing these specific risk factors may improve cardiovascular outcomes in Type 2 diabetes.
Abstract:
This study was aimed at evaluating the level of metabolic control and cardiovascular risk factors in a population of Type 2 diabetic patients with coronary artery disease. We used myocardial thallium-201 scintigraphy as a measure of coronary perfusion integrity. One hundred and forty six diabetic patients presenting with chest pain, ischaemic ECG changes or a positive exercise test underwent myocardial thallium-201 imaging perfusion in conjunction with exercise stress. Scintigrams were assessed by a computer assisted image analysis. The cardiovascular risk factors considered were sex, age, BMI and waist-hip ratio, smoking, systolic and diastolic blood pressure, serum lipids (total cholesterol and triglycerides), glycated haemoglobin A1, urinary albumin excretion, white blood cell count, and diabetes duration. The proportion of male diabetic subjects with a positive scintigraphy was 63% while that of diabetic women was 45% (p < 0.05). Mean age, anthropometric measures and diabetes indices were similar when diabetic patients with positive or negative scintigraphy were compared. The prevalence of patients with microalbuminuria and retinopathy (both non-proliferative and proliferative) was higher in positive (26% and 27%, respectively) than in negative (10% and 11%, respectively, p = 0.01) diabetic patients. Total cholesterol and white blood cell counts were also higher in positive diabetics (p < 0.05-0.01). These findings suggest that a cluster of risk factors (cholesterol, white blood cells, microalbuminuria) may be implicated in the development of coronary artery disease in Type 2 diabetes mellitus.