Mechanisms of Ischemic Heart Disease Development in Type 2 Diabetes Patients Based on Renal Function

DOI: https://doi.org/10.30702/ujcvs/24.32(04)/MM069-6166
Keywords: angina, myocardial ischemia, kidney function, invasive coronary angiography, stress-test, chronic kidney disease, microvascular angina, significant atherosclerotic lesions of the coronary arteries, comorbid pathology, old age

Abstract

Ischemic heart disease (IHD) remains a leading cause of mortality and disability in Ukraine and globally, primarily due to stenosing atherosclerosis of the coronary arteries. Type 2 diabetes mellitus (T2DM) is a significant factor accelerating atherogenesis, alongside with chronic kidney disease. Investigating the causes of myocardial ischemia in patients with IHD, T2DM, and cardio-renal-metabolic syndrome requires further exploration.

The aim. To investigate the prevalence of various causes of myocardial ischemia in patients with IHD and T2DM based on renal function.

Materials and methods. The study involved 103 patients with IHD and T2DM examined at the Ukrainian Children’s Cardiac Center in 2023. Participants were divided into two groups: 52 with IHD, T2DM, and stage 3A or higher chronic kidney disease; and 51 with IHD and T2DM. All the patients had angina pectoris; myocardial ischemia was confirmed in 47 (45.6%) cases by stress echocardiography and in 56 (54.4%) via exercise electrocardiography testing. Echocardio­ graphy with intravenous dipyridamole was performed to diagnose coronary microvascular dysfunction and determine coronary flow reserve. Renal function was assessed using estimated glomerular filtration rate (eGFR) based on the CKD‑EPI score.

Results. Demographic indicators were comparable: 32 (61.5%) / 20 (38.5%) men/women in the clinical group and 30 (58.8%) / 21 (41.2%) in the control group (p > 0.05); the mean age was 56.3 ± 0.3 and 57.1 ± 0.4 years (p > 0.05). Patients with eGFR <60 ml/min/1.73 m2 had a lower frequency of single-vessel disease and a higher proportion of threevessel disease compared to those with eGFR ≥60 ml/min/1.73 m2. In all patients without significant coronary artery disease, coronary flow reserve was less than 2. In the clinical group, significant atherosclerotic lesions were the cause of IHD more frequently (86.5%) compared to the control group (64.7%), while microvascular angina had a significantly higher frequency (13.5% vs. 35.3%).

Conclusion. In patients with IHD, T2DM and reduced glomerular filtration rate (eGFR <60 ml/min/1.73 m2), more aggressive coronary artery disease was observed. Consequently, the proportion of microvascular dysfunction as a cause of myocardial ischemia was higher in patients with eGFR ≥60 ml/min/1.73 m2. Therefore, a comprehensive approach in managing patients with comorbid conditions becomes an even more relevant topic for further research aimed at improving prognosis.

References

  1. Khan MA, Hashim MJ, Mustafa H, Baniyas MY, Al Suwaidi SKBM, Al Katheeri R, et al. Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study. Cureus. 2020;12(7):e9349. https://doi.org/10.7759/cureus.9349
  2. Jespersen L, Hvelplund A, Abildstrøm SZ, Pedersen F, Galatius S, Madsen JK, et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J. 2012;33(6):734-744. https://doi.org/10.1093/eurheartj/ehr331
  3. Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AHEM, et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J. 2020;41(37):3504-3520. https://doi.org/10.1093/eurheartj/ehaa503
  4. Marassi M, Fadini GP. The cardio-renal-metabolic connection: a review of the evidence. Cardiovasc Diabetol. 2023;22(1):195. https://doi.org/10.1186/s12933-023-01937-x
  5. Jia Q, Shi S, Yuan G, Shi J, Shi S, Wei Y, et al. The effect of nicorandil in patients with cardiac syndrome X: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020;99(37):e22167. https://doi.org/10.1097/MD.0000000000022167
  6. Ren H, Zhao L, Zou Y, Wang Y, Zhang J, Wu Y, et al. Association between atherosclerotic cardiovascular diseases risk and renal outcome in patients with type 2 diabetes mellitus. Ren Fail. 2021;43(1):477-487. https://doi.org/10.1080/0886022X.2021.1893186
  7. Düsing P, Zietzer A, Goody PR, Hosen MR, Kurts C, Nickenig G, et al. Vascular pathologies in chronic kidney disease: pathophysiological mechanisms and novel therapeutic approaches. J Mol Med (Berl). 2021;99(3):335-348. https://doi.org/10.1007/s00109-021-02037-7
  8. Palanca A, Castelblanco E, Perpiñán H, Betriu À, Soldevila B, Valdivielso JM, et al. Prevalence and progression of subclinical atherosclerosis in patients with chronic kidney disease and diabetes. Atherosclerosis. 2018;276:50-57. https://doi.org/10.1016/j.atherosclerosis.2018.07.018
  9. Crea F, Montone RA, Rinaldi R. Pathophysiology of Coronary Microvascular Dysfunction. Circ J. 2022;86(9):1319-1328. https://doi.org/10.1253/circj.CJ-21-0848
  10. Vancheri F, Longo G, Vancheri S, Henein M. Coronary Microvascular Dysfunction. J Clin Med. 2020;9(9):2880. https://doi.org/10.3390/jcm9092880
Published
2024-12-27
How to Cite
1.
Mankovskyi GB, Marushko YY, Dzhun YY, Stychynskyi OS. Mechanisms of Ischemic Heart Disease Development in Type 2 Diabetes Patients Based on Renal Function. ujcvs [Internet]. 2024Dec.27 [cited 2025Jan.21];32(4):61-6. Available from: https://cvs.org.ua/index.php/ujcvs/article/view/687
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 32 No 4 2024
Section
ISCHEMIC HEART DISEASE

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