J Korean Diabetes Assoc.  2006 Nov;30(6):435-441.

Effects of Type 2 Diabetes Mellitus on Risk Factors of Acute Coronary Syndrome

• Moon HJ
• Kang JG
• Jo MH
• Lee BW
• Park CY
• Lee SJ
• Hong EK
• Yu JM
• Kim DM
• Ihm SH
• Kim HK
• Rhim CY
• Choi MG
• Yoo HJ
• Park SW

Abstract

BACKGROUND: Diabetes mellitus (DM) is equivalent as well a risk factor of cardiovascular disease. We analyzed the effects of DM on clinical risk factors of acute coronary syndrome by comparing DM group with Non-DM group.
METHODS
A total of 847 (514 males and 333 females) patients with acute coronary syndrome was selected from 1664 patients who had undergone coronary angiography (CAG). These patients comprised 105 subjects with non-ST elevation myocardial infarction (MI), 313 with ST elevation MI and 429 with unstable angina. According to the presence of DM, we retrospectively reviewed the measured basic demographics, biochemical markers and coronary angiographic findings.
RESULTS
In the multivariated analysis, history of hypertension (P = 0.001), C-reactive protein (CRP) level (P = 0.001) and triglyceride level (P = 0.018) were independent risk factors in type 2 diabetic group. Also the frequency of multiple coronary vessel disease was higher in DM group than non-DM group on the coronary angiographic finding
CONCLUSIONS
Classic risk factors for acute coronary syndrome are strong predictors in patients with type 2 DM. Among these factors, the most important powerful risk factor is history of hypertension.

Keyword

Acute coronary syndrome; Diabetes mellitus; Risk factors

MeSH Terms

Acute Coronary Syndrome*
Angina, Unstable
Biomarkers
C-Reactive Protein
Cardiovascular Diseases
Coronary Angiography
Coronary Vessels
Demography
Diabetes Mellitus
Diabetes Mellitus, Type 2*
Humans
Hypertension
Male
Myocardial Infarction
Retrospective Studies
Risk Factors*
Triglycerides
C-Reactive Protein

Reference

5. Garacia MJ, Mcnammara PM, Gordon T, Kannell WB. Morbidity and mortality in diabetes in the framingham population: sixteen year follow up study. Diabetes. 1974. 23:105–111.

6. American Diabetes Association. Consensus development conference on the diagnosis of coronary heart disease in people with diabetes. Diabete Care. 1998. 21:1551–1559.

7. Braunwald E, Zipes DP, Libby P. Heart disease: a textbook of cardiovascular medicine. 2001. 6th ed. Philadelphia: WB Saunders;2133–2150.

8. Expert Panel on Detection, Evaluation, and Treatment of High blood cholesterol in adults. Execuative summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001. 285:2486–2497.

9. Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. N Engl J Med. 2000. 342:905–912.

10. National High Blood Pressure Education Program Working Group. National High Blood Pressure Education Program Working Group report on hypertension in diabetes. Hypertension. 1994. 23:145–160.

11. Jacobs DR Jr, Mebane IL, Bangdiwala SI, Criqui MH, Tyroler HA. High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the follow-up study of Lipid Research Clinics Prevalence Study. Am J Epidemiol. 1990. 131:32–47.

12. Schmidt SB, Wasserman AG, Muesing RA, Schlesselman SE, Larosa JC, Ross AM. Lipoprotein and apolipoprotein levels in angiographically defined coronary atherosclerosis. Am J Cardiol. 1985. 55:1459–1462.

13. Mazzone A, Servi SD, Ricevuti G, Mazzucchelli I, Fossati G, Pasotti D, Bramucci E, Angoli L, Marsico F, Specchia G, et al. Increased expression of neutrophil and monocyte adhesion molecule in unstable coronary artery disease. Circulation. 1993. 88:358–363.

14. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med. 1992. 326:242–250.

15. Anderson JL, carlquist JF, Muhlestein JB, Horne BD, Elimer SP. Evaluation of C-reactive protein, an inflammatory marker, and infections serology as risk factors for coronary artery disease and myocardial infarction. J Am Coll Cardiol. 1998. 32:35–41.

16. Patel P, Mendall MA, Carrington D, Strachan DP, Leatham E, Molineaux N. Association of Helicobacter pylori and Chlamydia pneumoniae infections with coronary heart disease and cardiovascular risk factors. BMJ. 1995. 311:711–714.

17. Saikku P, Leinonen M, Mattila K, Ekman MR, Nieminen MS, Huttunen JK. Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and myocardial infarction. Lancet. 1988. 29:983–986.

18. Grayston JT, Kuo CC, Campbell LA, Benditt EP. Chlamydia pneumoniae, strain TWAR and atherosclerosis. Eur Heart J. 1993. 14:suppl K. 66–71.

19. Gupta S, Leatham EW, Carrington D, Mendall MA, Kaski JC, Camm AJ. Elevated Chlamydia pneumoniae antibodies, cardiovascular events, and azithromycin in male survivors of myocardial infarction. Circulation. 1997. 96:404–407.

20. Muhlestein JB, Hammond EH, Carlqurist JF, Radicke E, Thromson MJ, Karagounis La. Increased incidence of Chlamydia species within the coronary arteries of patients with symptomatic atherosclerotic versus other forms of cardiovascular disease. J Am Coll Cardiol. 1996. 27:1555–1561.

21. Syvanne M, Pajunen P, Kahri J, Lahdenpera S, Ehnholm C, Nieminen MS, Taskinen MR. Determinant of severity and extent of coronary artery disease in patients with type 2 diabetes and in nondiabetic subjects. Coronary Artery Disease. 2001. 12:99–106.

22. McGiure DK, Emanuelsson H, Granger CB, Magnus Ohman E, Moliterno DJ, White HD, Ardissino D, Box JW, Califf RM, Topol EJ. GUSTO-IIB investigators. Influncence of diabetes mellitus on clinical outcomes across the spectrum of acute coronary syndromes. Eur Heart J. 2000. 21:1750–1758.

23. Bakhai A, Collinson J, Flather MD, Perez de Arenaza D, Shibata MC, Wang D, Adgey JA. Diabetic patients with acute coronary syndromes in UK: high risk and under treated. Results from the prospective registry of acute ischemic syndromes in UK. Int J Cardiol. 2005. 100:79–84.

24. United Kingdom Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998. 352:837–853.

25. DCCT Reserch Group. The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulindependent diabetes mellitus. N Engl J Med. 1993. 329:977–986.

26. United Kingdom Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ. 1998. 317:703–713.

27. Stratton IM, Adler AI, Neil HA, Matthewa DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS35): Prospective Observational study. BMJ. 2000. 321:405–412.