Danylo Halytsky Lviv National Medical University
Introduction. According to various international registries, the proportion of patients with type 2 diabetes mellitus in a cohort of patients with acute coronary syndrome ranges from 22.0 to 34.0 %. The onset of acute coronary syndrome in those patients occurs, on average, 14.6 years sooner than in patients without diabetes. Diabetes mellitus in patients within first 30 days after myocardial infarction and within next 1–5 years is associated with a higher hospital and general mortality.
Aim. To find out the clinical and functional peculiarities of the acute coronary syndrome and concomitant type 2 diabetes mellitus.
Materials and methods. 102 patients (49 men and 53 women, aged 54 – 75 years) were examined. Depending on the clinical variant of acute coronary syndrome and the presence or absence of concomitant diabetes, patients were stratified into the following groups: the first group included 60 patients with unstable angina and with non-ST myocardial infarction, including 33 patients with diabetes and 27 patients without diabetes; the second group included 42 patients with ST myocardial infarction, which included 24 patients with diabetes and 18 patients with- out diabetes.
Results and discussion. In patients with acute coronary syndrome and concomitant type 2 diabetes mellitus was recorded a late hospitalization in specialized departments, increased heart rate and a greater number of episodes of sinus tachycardia, higher levels of systolic and diastolic blood pressure, the greater size of the left atrium, increasing blood glucose levels and also atherogenic dyslipidemia.
For patients with unstable angina and non-ST myocardial infarction the presence of concomitant type 2 diabetes, characterized by lower indices of left ventricular ejection fraction and slightly higher prevalence of symptoms of acute heart failure were observed. In patients with ST myocardial infarction and diabetes increased interventricular septum thickness, posterior wall of the left ventricle, prolongation of QT interval and a slightly higher tendency of patients to ventricular tachycardia and ventricular fibrillation compared with patients without diabetes were observed.
Conclusions. Patients with the acute coronary syndrome and concomitant type 2 diabetes were characterized by late hospitalization in specialized departments, apparently due to the presence of atypical and silent disease that requires diagnostic coronarography for further diagnosis. The flow of acute coronary syndrome in these patients was characterized by a higher heart rate, higher blood pressure, prolongation of QT interval, frequent arrhythmias and signs of acute heart failure and subsequently with poorer prognosis.
- Kyyak Y, Barnett O, Kovalyshyn V et al. Correlations between clinical and cell cardiology. Lviv: Quart, 2012. p. 17-20. (Ukrainian).
- Brieger D, Eagle KA, Goodman SG, Steg PG, Budaj A, White K et al. Acute Coronary Syndromes Without Chest Pain, An Underdiagnosed and Undertreated High-Risk Group. Grace Chest. 2004;126(2):461-469. https://doi.org/10.1378/chest.126.2.461
- AlFaleh H, Elasfar AA, Ullah A, AlHabib KF, Hersi A, Mimish L et al. Acute heart failure with and without acute coronary syndrome: clinical correlates and prognostic impact (From the HEARTS registry). BMC Cardiovasc Disord. 2016;16(1):98. https://doi.org/10.1186/s12872-016-0267-6
- Aronson D, Edelman ER. Revascularization for coronary artery disease in diabetes mellitus: Angioplasty, stents and coronary artery bypass grafting. Rev Endocr Metab Disord. 2010;11(1):75-86. https://doi.org/10.1007/s11154-010-9135-3
- Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ et al. Detection of silent myocardial ischemia in asymptomatic diabetic subjects. Diabetes Care. 2004;27:1954-1961. https://doi.org/10.2337/diacare.27.8.1954
- Keller PF, Carballo D, Roffi M. Diabetes in acute coronary syndromes. Minerva Med. 2010;101(2):81-104.
- Asghar O, Al-Sunni A, Khavandi K, Khavandi A, Withers S, Greenstein A et al. Diabetic cardiomyopathy. Clin Sci. 2009;116(10):741-760. https://doi.org/10.1042/CS20080500
- Dimitropoulos G, Tahrani A, Stevens M. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes. 2014;5(1):17-39. https://doi.org/10.4239/wjd.v5.i1.17
- Eguchi M, Xu G, Li R, Sweeney G. Diabetes influences cardiac extracellular matrix remodelling after myocardial infarction and subsequent development of cardiac dysfunction. J Cell Mol Med. 2012;16(12):2925-2934. https://doi.org/10.1111/j.1582-4934.2012.01613.x
- Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551-2567. https://doi.org/10.1093/eurheartj/ehs184
- Giaccari A, Sorice G, Muscogiuri G. Glucose toxicity: the leading actor in the pathogenesis and clinical history of type 2 diabetes – mechanisms and potentials for treatment. Nutr Metab Cardiovasc Dis. 2009;19(5):365-377. https://doi.org/10.1016/j.numecd.2009.03.018
- Granger CB, Povsic TJ. Another biomarker for risk assessment in acute myocardial infarction? J Am Coll Cardiol. 2014;64(16):1708-1710. https://doi.org/10.1016/j.jacc.2014.06.1200
- Grossman E, Messerli FH. Diabetic and hypertensive heart disease. Ann Intern Med. 1996;125(4):304-310. https://doi.org/10.7326/0003-4819-125-4-199608150-00009
- Gruppetta M, Calleja N, Fava S. Long-term survival after acute myocardial infarction and relation to type 2 diabetes and other risk factors. Clin Cardiol. 2010;33(7):424-429. https://doi.org/10.1002/clc.20776
- Cox AJ, Azeem A, Yeboah J, Soliman EZ, Aggarwal SR, Bertoni AG et al. Heart Rate–Corrected QT Interval Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Individuals With Type 2 Diabetes: the Diabet Heart Study. Diabet Care. 2014;37(5):1454-1461. https://doi.org/10.2337/dc13-1257
- Whiting DR, Guariguata L, Weil C, Shaw J. IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabet Res Clin Pract. 2011;94(3):311-321. https://doi.org/10.1016/j.diabres.2011.10.029
- Kumar A, Singh V. Atherogenic dyslipidemia and diabetes mellitus: what’s new in the management arena? Vasc Health Risk Manag. 2010;6:665-669. https://doi.org/10.2147/VHRM.S5686
- Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetec subjects with and without prior myocardial infarction. N Engl J Med. 1998;339(4):229-234. https://doi.org/10.1056/NEJM199807233390404
- Njeim M, Chedrawy G. Diabetes and Coronary Heart Disease. Eur J Prev Cardiol. 2015;22(6):779-787.
- Brophy S, Cooksey R, Gravenor MB, Weston C, Macey SM, John G et al. Population based absolute and relative survival to 1 year of people with diabetes following a myocardial infarction: a cohort study using hospital admissions data. BMC Public Health. 2010;10:338. https://doi.org/10.1186/1471-2458-10-338
- Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and CVD in men and women with diabetes compared with non-diabetic people: a population – based retrospective cohort study. Lancet. 2006;368(9529):29-36. https://doi.org/10.1016/S0140-6736(06)68967-8
- Pilgrim T, Vranckx P, Valgimigli M, Stefanini GG, Piccolo R, Rat J et al. Risk and timing of recurrent ischemic events among patients with stable ischemic heart disease, non-ST-segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction. Am Heart J. 2016;175:56-65. https://doi.org/10.1016/j.ahj.2016.01.021
- Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabet Res Clin Pract. 2010;87(1):4-14. https://doi.org/10.1016/j.diabres.2009.10.007
- Sowers JR. Treatment of hypertension in patients with diabetes. Arch Intern Med. 2004;164(17):1850-1857. https://doi.org/10.1001/archinte.164.17.1850