Patologìâ (Oct 2020)
Peculiarities of clinical and metabolic profile of patients with coronary artery disease associated with type 2 diabetes mellitus (retrospective analysis)
Abstract
Coronary artery disease (CAD) is one of the most common reasons of disability and mortality. Diabetes mellitus occurs in 30% of patients with IHD and aggravates the course of the underlying disease, worsens the prognosis and quality of life. However, the clinical features of this comorbidity are not fully understood. Aim of the study: to determine the effect of type 2 diabetes mellitus on the clinical and metabolic features of patients with coronary artery disease. Materials and methods. Retrospective analysis of 256 medical records of inpatients with CAD (males – 106, females – 150, age – 66 (59; 71) years) was performed. The patients were divided into two groups: Group 1 (main) – 213 patients with CAD with type 2 DM; Group 2 (comparison) – 43 patients with isolated CAD. Statistical processing was carried out using Statistica 13.0 software package. Results. It was found that the course of CAD in diabetic patients is associated with higher frequency of cardiovascular complications (arrhythmias, atherothrombotic events). It has been found, that in patients with CAD associated with type 2 DM, body mass index (by 9.39 %), levels of systolic (by 9.28%) and diastolic (by 9.09 %) blood pressure, glucose (by 53.92 %), glycated hemoglobin (by 45.81 %), total cholesterol (by 11.13 %), triglycerides (by 18.86 %) exceeded the corresponding indicators in patients with isolated CAD (P < 0.05). Multicomponent metabolic syndrome was reported in 89 % of patients with type 2 DM. In patients with CAD, associated with type 2 DM, if compared to CAD patients without DM, the ejection fraction of the left ventricle (EF LV) was significantly lower by 15.22 %, and the mean pulmonary artery pressure (mPAP) was significantly higher by 29.41 %. The frequency of LV systolic dysfunction (χ2 = 2.75; df = 1; P < 0.05) and an increase of mPAP (χ2 = 2.87; df = 1; P < 0.05) in patients with CAD and type 2 DM was also significantly higher. The calculation of the relative risk allowed to establish the interrelationship between type 2 DM with the risk of developing of LV systolic dysfunction (RR = 2.238; CI 1.322–3.788; P < 0.05) and increased mPAP (RR = 3.337; CI 1.293–8.615; P < 0.05). Concentric left ventricular hypertrophy (77 %) was predominant in patients with CAD and type 2 DM, and in patients with isolated coronary heart disease a concentric LV remodeling (69 %) was dominating. Conclusions. Concomitant diabetes mellitus affects negatively the course of CAD by increasing the frequency of arrhythmias and atherothrombotic events. In patients with CAD and type 2 DM a multicomponent metabolic syndrome prevails, that is characterized by proatherogenic changes in the lipid profile, higher degree of hypertension and obesity. The intensity of cardiac remodeling in patients with CAD was higher in the presence of type 2 DM, which is confirmed by the formation of a prognostically unfavorable type of LV remodeling on the background of the LV systolic function decrease and significant mPAP increase.
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