Angiographic characteristics of the lesions of coronary arteries in patients with ischemic heart disease and diabetes mellitus
Abstract
The course of acute coronary syndrome in patients with diabetes mellitus is characterized by the higher mortality and more common complications. The reasons for this remain not fullyunderstood.
The aim of this study was to investigate the angiographic characteristics of atherosclerotic lesions of coronary arteries in patients with ischemic heart disease and diabetes mellitus and to compare the location and severity of lesions in those patients with and without diabetes. We studied 455 patients with clinical signs of ischemic heart disease which were divided for 2 groups – with diabetes mellitus (229 patients) and without diabetes (226 subjects). We found that patients with diabetes had significantly more generalized lesions of coronary arteries compared to non-diabetic subjects. There was significantly higher number of patients with the presence of atherosclerotic plagues in 3 coronary arteries in the group of subjects with diabetes compared to those patients without diabetes. Contrary, the damage of 1 coronary artery was more common in the group of patients without diabetes. The revealed peculiarities of angiographic characteristics of coronary lesions in patients with diabetes mellitus could underlie the worse course and outcome of ischemic heart disease in these subjects and dictate the need for individualized approaches for the treatment of patients with ischemic heart disease and diabetes mellitus.
References
2. U.S. Food and Drug Administration. Guidance for in-dustry: diabetes mellitus evaluating cardiovascular risk in new antidiabetic therapies to treat type 2 diabetes [In-ternet]. Available from www.fda.gov/downloads/Drugs/ GuidanceComplianceRegulatoryInformation/Guidances/ ucm071627.pdf. Accessed 31 October 2016
3. American Diabetes Association. Standards of medical care in diabetes – 2014 // Diabetes Care. – 2014. – Vol. 37 (Suppl 1). – P. 14–80.
4. A review of FDA guidance: understanding the FDA guid-ance on assessing cardiovascular risks for new antidiabetic therapies [Internet] / Caveney E., Turner J. R. White // Available from http://www.quintiles.com/library/white-papers/newfda-guidance-on-antidiabetic-therapies. Ac-cessed 31 October 2016.
5. Effects of once-weekly exenatide on cardiovascular out-comes in type 2 diabetes / Holman R. R., Bethel M. A., Mentz R. J. et al.; EXSCEL Study Group // N Engl J Med. – 2017. – Vol. 377. – P. 1228–1239.
6. Oral glucose tolerance test and HbA1c for diagnosis of dia-betes in patients undergoing coronary angiography the Si-lent Diabetes Study / Doerr R., Hoffmann U., Otter W. et al. // Diabetologia. – 2011. – Vol. 54. – Р. 2923–2930.
7. ESC Guidelines on diabetes, pre-diabetes, and cardio-vascular diseases developed in collaboration with the EASD // Eur. Heart. J. – 2013. – Vol. 34. – Р. 3035–3087. doi: https://doi.org/10.1093/eurheartj/eht108
8. Efficacy and safety of degludec versus glargine in type 2 diabetes / Marso S. P., McGuire D. K., Zinman B. et al.; DEVOTE Study Group // N Engl J Med. – 2017. – Vol. 377. – P. 723–732.
9. Effects of acarbose on cardiovascular and diabetes out-comes in patients with coronary heart disease and impaired glucose tolerance (ACE): a randomised, double-blind, placebo controlled tria / Holman R. R., Coleman R. L., Chan J. C. N. et al.; ACE Study Group // Lancet Diabetes Endocrinol. – 2017. – Vol. 5. – P. 877–886.
10. Cardiovascular outcome trials for anti-diabetes medication: a holy grail of drug development? / John M., Gopalakrishnan Unnikrishnan A., Kalra S., Nair T. // Indian Heart J. – 2016. – Vol. 68. – P. 564–571.
11. Nine-year effects of 3.7 years of intensive glycemic control on cardiovascular outcomes / ACCORD Study Group // Diabetes Care. – 2016. – Vol. 39. – Р. 701–708.
12. Mortality and cardiovascular disease in type 1 and type 2 diabetes / Rawshani A., Rawshani A., Franz´en S. et al. // N Engl J Med. – 2017. – Vol. 376. – P. 1407–1418.
