The risk of coronary artery disease in patients with type 2 diabetes mellitus and metabolic syndrome

Abstract

Background. The relevance of this work is due to the growing need for a personalized approach to the management of patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) that arose on the background of metabolic syndrome (MS) and determining the individual risk for each patient. The purpose of the study was to find out the methodology for determining the individual risk of complications in each patient with metabolic syndrome using lipid, carbohydrate and hormonal parameters. Materials and methods. A study of 319 patients with MS was conducted. Six clinical groups were formed. The first group included 82 patients with MS, the second — 39 patients with T2DM (compensation state) in the background of MS, the third — 35 patients with T2DM (decompensation state) in the background of MS, the fourth — 44 patients with CAD in the background of MS, the fifth — 44 patients with CAD and T2DM (compensation state) in the background of MS, the sixth group — 75 patients with CAD and T2DM (decompensation state) in the background of MS. The control group consisted of 40 healthy individuals. Women accounted for 69.9 % of all patients and men for 30.1 %. The methodology for determining the individual risk of CAD in each patient with MS (with/without T2DM) was calculated using the above indicators with a further construction of a prognostic probability model. Results. Patients with T2DM had pronounced changes in carbohydrate metabolism in the presence of decompensation. Changes in lipid metabolism among all groups in CAD and T2DM (state of decompensation) with MS turned out to be non-specific. Interrelated changes in thyroid-stimulating hormone, cortisol, prolactin, and insulin were revealed in patients depending on the form and severity of syntropic pathology. Given the above parameters, a model for determining the personalized risk of CAD for each patient with MS (with/without diabetes) was calculated. Fifteen factors were selected, which, according to our own observations, could influence the development of CAD in patients with MS. At the same time, 10 factors were identified that had a reliable influence on the development of CAD. The preventive nature of high-density lipoprotein cholesterol and prolactin (in women) effect on the occurrence of CAD and the provoking influence of diabetes, age, triglyceride, thyroid-stimulating hormone, cortisol levels, body mass index, and glycated hemoglobin were revealed. Their regression coefficients were determined, the reliability was checked using the Wald method, and the whole model was checked using the chi-square, the accuracy of the model was 79.4 %, the specificity was 77.3 %, and the sensitivity was 81.9 %. Conclusions. Patients with MS had an increase in the level of insulin and HOMA-IR, a shift in the lipid spectrum; an increase in the level of prolactin in women, thyroid-stimulating hormone and cortisol against the background of normal values of free thyroxine. Decompensation of T2DM was accompanied by an increase in cortisol at normal levels of thyroid-stimulating hormone, in contrast to the state of T2DM compensation, prolactin in women was significantly increased, regardless of compensation. A method for calculating the individual risk of coronary artery disease in a patient with metabolic syndrome using anthropometric indicators, carbohydrate and lipid spectrum, cortisol, prolactin and thyroid-stimulating hormone is proposed.

Keywords

• metabolic syndrome
• type 2 diabetes
• coronary artery disease
• prediction
• risk factors