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Early Detection Of Asymptomatic Coronary Artery Disease In Patients With Type 2 Diabetes Mellitus

OBJECTIVE: To determine the prevalence of coronary artery disease (CAD) risk factors (RF) and myocardial ischemia in a sample of asymptomatic diabetic patients treated on an outpatient basis. We examined the associations between several clinical and laboratory variables and a high-risk stress SPECT imaging scan in 1,427 asymptomatic diabetic patients without known coronary artery disease (CAD). The relationship between lipoprotein(a) [Lp(a)], apolipoprotein(a) [apo(a)] polymorphism, and silent CAD has never been studied. SUBJECTS–136 Diabetic subjects, of whom 72 (33 women, 39 men (mean age 46.0] were insulin dependent and 64 (19 women, 45 men (mean age 49.3] non-insulin dependent. The titres in some were shown to rise and fall over the years, while in others they remained remarkably constant. Risk factors for ASB in type 1 diabetic women included a longer duration of diabetes, peripheral neuropathy, and macroalbuminuria. Mean LVEF at rest and after exercise in the normal group was 66 +/- 7% and 76 +/- 9%, respectively.

In this issue of the Journal, Peix et al22 report the results of an interesting study. They investigated in 59 asymptomatic patients with type 2 DM the prevalence of ischemia detected by SPECT MPI, and compared it to a control group of 42 age and sex matched non-diabetic volunteers, who also had risk factors for CAD. Coronary artery disease (CAD) accounts for 70-80% of mortalities in diabetic patients, and type 2 diabetes mellitus (DM) is an important risk factor [1]. Many women with resolution of initial bacteriuria, with or without antibiotics, became bacteriuric again during follow-up. To date, two large trials have examined the utility of non-invasive imaging tests to evaluate asymptomatic individuals with DM. In addition, vessel wall volume in patients with carotid arteries positive for intraplaque hemorrhage was significantly larger than volume in those with no IPH. This could be explained by the effects of intervention or by the low event rate in the background population.

The purpose of our study is to examine the prevalence of ischemia by SPECT perfusion imaging performed during symptom limited treadmill or bicycle exercise and compare it to an age and sex-matched control group with no diabetes but with multiple coronary risk factors. To overcome these limitations, several previous studies were conducted to develop more sensitive diagnostic methods, such as single photon emission computerized tomography (SPECT) [6] and multi-detector coronary CT [7]. The adverse prognostic significance of ST-segment depression with adenosine is well documented in patients referred for evaluation (3,4). Thus, no proper diagnostic test exists for the early diagnosis of asymptomatic CAD. In the present study, TMT and coronary arterial angiography (CAG) were performed in asymptomatic type 2 diabetic patients, regardless of the number of CVD risk factors present, to determine the best CAD predictor in these patients. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial suggested the role of CAN as a possible predictor for CVD mortality [5]. ( 5) review the literature regarding the use of noninvasive imaging modalities for the screening of asymptomatic patients with diabetes.

Patients were excluded if they 1) had clinical symptoms of typical angina or chest pain, or had undergone tests for CVD (TMT, exercise echocardiography, myocardial SPECT, and CAG); 2) had abnormal ECG findings during CVD tests such as TMT, myocardial SPECT, and CAG; and 3) were previously diagnosed or treated for non-CAD heart diseases such as an inherited cardiac disorder, cardiac valve disease, heart failure, or arrhythmia. We also excluded cases with ambiguous information related to CVD. These results highlight the atherosclerotic heterogeneity of asymptomatic diabetic patients, which was essential to identify and would not be possible without CT. Coronary arterial angiography was conducted in patients with positive or equivocal TMT results, for example, test discontinuation due to a decline in exercise ability. Our study has some limitations. This study was approved by the Hospital Ethics Committee, and informed consent for coronary angiography was obtained from all patients. Age, gender, height, and body weight were measured.

The body mass index (BMI) was calculated at the time of testing. Obesity was defined as a BMI ≥25. When the fast-Fourier transform was used, the following frequency domain indexes were obtained: total power (TP), high-frequency power (HFP) and low-frequency power (LFP), expressed in milliseconds squared. A family history of CAD was defined as a diagnosis of myocardial infarction or angina pectoris among first relatives. Those with a smoking history were defined as smokers regardless of current smoking status or amount of smoking. Hypertension was defined as taking anti-hypertensive medication, a systolic pressure ≥140 mmHg, or a diastolic pressure ≥90 mmHg on two separate occasions, as defined by the World Health Organization. Eur Heart J.

This results in a mean risk of 1.03 per year within the group. Type 2 DM patients were defined as: 1) diagnosed and received treatment for DM, 2) random blood glucose level ≥200 mg/dl with diabetic symptoms based on the ADA diagnostic criteria, or 3) fasting blood glucose level of ≥126 mg/dl. In our study population, 35% of the patients with SMI had CAD. Diabetic retinopathy was defined as 1) a diagnosis by fundoscopic examination (by a professional ophthalmologist) and 2) a history of photocoagulation treatment due to diabetic retinopathy. Diabetic neuropathy was defined as the presence of neuropathic symptoms (paresthesia, pain), signs of sensory loss (loss of light touch, pinprick, cold, vibration in the toes), abnormal findings on the Semmes-Weinstein monofilament test, and nerve conduction velocity measurements. Diabetic nephropathy was defined as the appearance of abnormal urinary albumin levels; microalbuminuria (30-299 mg albumin/24 hours) and macroalbuminuria (>300 mg albumin/24 hours). Fasting plasma glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride, and high-density lipoprotein (HDL)-cholesterol were measured.

The Friedewald equation (LDL-cholesterol=total cholesterol-HDL cholesterol – triglyceride/5) was used to calculate low-density lipoprotein (LDL)-cholesterol if triglyceride was 80% (severe case), a Percutaneous coronary intervention (PCI) including balloon angioplasty and stent insertion was performed with or without the aid of intravascular ultrasound. Tobacco use and high levels of glycosylated haemoglobin during the pre-transplantation evaluation are associated with CAD in these patients.

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