Asymptomatic Coronary Artery Disease in Type 2 Diabetes Mellitus Patients Compared to a Non-Diabetic Control Group (original) (raw)
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Asymptomatic Coronary Artery Disease in TYPE-2 Diabetes
Pakistan Journal of Medical Sciences, 2009
Objective: To select a subgroup of type-2 diabetics with two additional prespecified risk factors to see that whether there is any benefit of screening such patients. Methodology: Five hundred twenty six patients were sent for treadmill stress test or thallium scan. Those who had abnormal results were advised coronary angiography. The angiographically proven CAD was correlated with various risk factors to find the relationship between the disease and variables. Results: Two hundred thirty five (48%) patients had abnormal results and among them 158 (67%) underwent coronary angiography. Among these 21% had evidence of CAD. Coronary artery bypass grafting (CABG) was performed in 35(33%) patients, catheter based intervention (PCI) in 44(40%) patients and 30(27%) patients were not suitable for intervention. Duration of diabetes, smoking, diabetic retinopathy, albuminuria, and peripheral vascular disease were significant predictor of asymptomatic CAD. Conclusion: This study has demonstrat...
Detection of Coronary Artery Disease in Asymptomatic Patients With Type 2 Diabetes Mellitus
Background/Aims: In type 2 diabetic patients, coronary artery disease (CAD) is usually detected at an advanced stage due to a lack of symptoms. The aim of this study was to define which clinical parameters or noninvasive tests predict CAD in asymptomatic type 2 diabetic patients. Methods: One hundred fourteen asymptomatic type 2 diabetic patients were divided into two groups based on the number of cardiovascular disease (CVD) risk factors (group A ≥2, group B ≤1). Treadmill exercise ECG tests (TMT) were conducted in all cases, and coronary artery angiography was performed on TMT-positive patients. Clinical parameters, diabetic status, and coronary angiographic findings were analyzed. Results: The prevalence of CAD was 41.0% in group A and 16.7% in group B. The number of risk factors was significantly correlated with the prevalence of CAD, but not with the severity of CAD. Multivariate analysis showed that family history of CAD (odds ratio [OR]=9.41; 95% confidence interval [CI], 1.60-55.49) and diabetes duration ≥10 years (OR=3.28; 95% CI, 1.29-8.84) were independent CAD risk factors in asymptomatic patients. Conclusions: We recommend a routine screening for CAD in type 2 diabetic patients who have a longer (≥10 years) diabetic duration or a family history of CAD, even if they are asymptomatic for CAD. (Korean J Intern Med 2009;24:183-189)
Journal of The American College of Cardiology, 2001
The goal of this research was to study coronary atherosclerosis in patients with type 2 diabetes compared with patients without diabetes according to the new definition of diabetes advocated by the American Diabetes Association in 1997. BACKGROUND Patients with diabetes (fasting plasma glucose above 7.0 mM/L) have a higher risk of cardiovascular death. The correlation with the pattern and severity of their coronary atherosclerosis, especially in the new patients with "mild" diabetes (7.0 mM/L Յ fasting plasma glucose Ͻ 7.8 mM/L), remains unclear.
Early detection of coronary artery disease in asymptomatic type 2 diabetes mellitus patients
International Journal of Advances in Medicine, 2015
Type 2 diabetes mellitus is an important risk factor for Coronary Artery Disease (CAD). The Framingham Heart study revealed increase incidence from one to five fold of CAD, MI, CHF, PAD and sudden death in type 2 diabetes mellitus patients. 1 CAD accounts for 70-80% of motilities in DM. 5 The absence of chest pain is common (silent ischemia) in type 2 DM patients. It is difficult to diagnose CAD at proper time because of asymptomatic nature of the disease progression. 2,7 The prognosis of individual with type 2 diabetes who have coronary artery involvement worse than non-diabetic due to involvement of multiple vessels. 1,5,6 American Diabetes Association (ADA) recommends that treadmill exercise test (TMT) and/or coronary angiography should be done in diabetic patients having additional cardiovascular risk factors. 2 More sensitive diagnostic methods such as Single Photon Emission Computerized Tomography (SPECT) and multi-detector coronary MDCT may be done. But those diagnostic approaches cannot be done for asymptomatic patients on an out patients basis. 7 No unanimous accepted test suggested for early diagnosis of asymptomatic CAD.
Diagnosis of Coronary Artery Disease in Persons with Diabetes Mellitus
Current Diabetes Reports, 2012
Coronary heart disease (CHD) is the leading cause of morbidity and mortality in patients with diabetes. Asymptomatic CHD in these patients is elusive and carries a poor prognosis given the fact that an unheralded acute myocardial infarction or sudden cardiac death frequently constitutes its first presentation. Because effective screening for asymptomatic patients with type 2 diabetes for both the presence and severity of CHD is intuitively appealing, we have summarized the utility and prognostic value of various diagnostic modalities (both functionally and anatomically) in enhancing risk stratification and leading to improved and more aggressive management of the risk factors. There exist some evidence and recommendations for screening of asymptomatic persons with diabetes using certain modalities. More research is needed to define potential subsets of patients with diabetes who may benefit from additional testing for asymptomatic CHD.
Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus
International Heart Journal, 2012
Diabetic patients with coronary artery disease are often asymptomatic, making appropriate care of such patients difficult. The purpose of this study was to investigate the prevalence of coronary lesions in asymptomatic diabetic patients. Coronary computed tomography (CT) angiography was performed in 120 consecutive diabetic patients (90 of whom were men, mean age 65, mean HbA1c 7.2%). Images from patients whose coronary artery calcium scores (CAC scores) were less than 400 were subjected to stenosis and plaque analysis. Significant stenosis was defined as coronary artery stenosis > 70%. High-risk plaque was defined as plaque having both a CT density < 30 Hounsfield Units (HU) and showing positive remodeling. Significant stenoses were identified in 30.5% of the patients. High-risk plaques were identified in 17.1% of the patients. Less than half of the high-risk plaques were obstructive plaques. There was a statistically significant association between significant stenosis and high-risk plaque by chi-square test (P = 0.022). We found significant stenosis even in patients whose CAC score = 0 at a rate of 5.0%. Using univariate logistic-regression analysis, we found that coronary risk factors associated with significant stenosis and high-risk plaque were dyslipidemia (P = 0.033) and current smoking (P = 0.030), respectively. We report for the first time, the prevalence of high-risk plaques in the arteries of patients with asymptomatic diabetes, as assessed by coronary CT angiography.
Coronary CT Angiography in Asymptomatic Diabetes Mellitus
Annals of International medical and Dental Research, 2016
Background: Coronary artery disease is often asymptomatic in diabetic patients until the onset of myocardial infarction or sudden cardiac death. . Coronary artery CT angiography can detect Coronary artery disease with high specificity and sensitivity. Aims &objectives: To evaluate the prevalence of coronary artery disease by CT angiography in type 2 diabetes mellitus patients asymptomatic for coronary artery disease with one or more additive risk factors for coronary artery disease. Methods: This hospital based observational study was conducted from March 2013 to August 2014 at GMC Srinagar. This study was carried out among Type 2 diabetes mellitus patients asymptomatic for coronary artery disease with one or more additional risk factors for coronary artery disease. Total of 52 patients with Type 2 diabetes patient underwent Cardiac CT. Results: Mean age of study population was 57.08 ±9.33 years..34 were males and 18 were females. 65.39% of total patient who underwent CT Angiography had plaque in coronary arteries while 34.61% have no plaque and normal coronary vessels. 19.23% patients have significant stenosis defined by luminal narrowing more than 70%. There was statistically significant relation between those who have patient significant stenosis and nonsignificant stenosis with regards to mean age, BMI, duration of diabetes , HDL ,LDL ,total cholesterol ,TG, HbA1c and coronary calcium score. Conclusion: Asymptomatic diabetics with additional risk factors have high prevalence of atherosclerotic plaques with 19% having obstructive CAD .The timely detection of CAD can help in optimizing treatment.
Prevalence of Coronary Artery Disease in Asymptomatic Type II Diabetics
The Journal of Medical Research, 2020
Background: Diabetes Mellitus is a major leading cause of mortality & morbidity all over the world. Most of the diabetic patients have coronary artery disease (CAD) as cause of death which usually go unnoticed during their course of disease. Rose Angina questionnaire is standardised tool for detection of CAD. In present study we have analysed the prevalence of CAD & also correlated Rose Angina questionnaire with ECG changes in asymptomatic diabetics. Methodology: A cross sectional study of 118 participants was conducted at Tertiary hospital, Thane. Pre-diagnosed diabetics with no cardiovascular symptoms were included as participants & other undiagnosed or pre-diagnosed symptomatic were excluded from the study. Rose Angina questionnaire was given to them & ECG was taken for all participants. Prevalence of various categories of ECG was calculated. Pearson's Correlation coefficient was calculated in between variables with the help of statistical software SPSS-20. Result: Out of 118 participants, 63 were female and 35 were male. The prevalence of Normal ECG is 78.81%, CAD ECG is 18.64% & Coincidental ECG is 2.54%. Correlation between Rose Angina Questionnaire & ECG reflected as weak positive correlation for Angina and ECG (Correlation coefficient 0.0210), weak uphill positive linear correlation for possible infarction and ECG (Correlation coefficient 0.2458) and weak downhill negative linear correlation for claudication and ECG (Correlation coefficient-0.0275). Conclusion: In present study, emphasis on significance of recording ECG even in asymptomatic diabetic patients during frequent intervals irrespective of the presence of symptoms related to CAD is established. It is observed that ECG changes usually do not match with clinical symptoms & silent CAD is common in diabetics. Weak positive correlation between Rose Angina questionnaire & ECG was observed which is suggestive of asymptomatic CAD.
International Journal of Advances in Medicine, 2016
Background: Diabetes mellitus is one of the commonest disease worldwide ranking next to cardiovascular disorder. The estimated prevalence of diabetes among adults is expected to rise about 100% in future. Cardiac involvement in diabetes commonly manifests as CAD and less commonly as dilated (diabetic) cardiomyopathy and autonomic cardiovascular neuropathy. The risk of CAD among diabetic patients is directly related to the levels of blood pressure, cigarette smoking and total cholesterol. Methods: The present study was undertaken at Chandulal Chandrakar memorial hospital, Bhilai, Chhattisgarh (India) between the periods of September 2010-2012 (2 years). 120 cases of CAD were studied, out of which 60 cases are diabetic CAD and 60 cases are non-diabetic CAD. Sample is drawn by simple random technique. Ethical approval was obtained from institutional ethical committee. Total Cases-120, Diabetic CAD [group-1]-60 and Non-diabetic CAD [group-2]-60. On recruiting the subjects into Group 1 and Group 2 following protocol is followed-history, clinical examination, pt. stabilization, anthropometric measurement, routine investigations, specific investigations including echocardiography. Procedures, definitions and criteria were used in the study as per standard protocol. In the present study values are expressed as mean ±1 SD. Demographic characteristics of patient with or without diabetes and other unpaired variables were compared. Results: Mean age in diabetic group was (55.7 ± 9.5) years while in non-diabetic group (55.6 ± 9.32) years. Diabetic group consists of 42 males and 18 females. Non Diabetic Group consists of 38 males and 22 females. Most of the patients in diabetic group presented with chest pain with sweating and with symptoms of sympathetic stimulation (vomiting/ apprehension 83.33%). A small fraction of diabetic patients presented with breathlessness-20%, syncope (3.33%) and palpitation (8.3%). In diabetic group 55% of patients were hypertensive, pre-HTN was seen in 18.33% and 26.66% had optimal blood pressure. Non-diabetics have higher ideal body weight 58.33% than diabetic (36.66%). Among the diabetic group and non-diabetic group maximum number of cases belonged to low risk category with total cholesterol, triglycerides and LDL cholesterol, but with borderline risk with HDL cholesterol. Diabetics are more vulnerable to mortality than non-diabetics (p<0.05). Conclusions: Diabetics had considerably higher percent of typical and atypical presentation. Hence, CAD should be considered as one of the differential diagnoses in diabetics who have presented with chest pain, however less severe it may be.
Comparative Study of Coronary Angiographic Findings Between Diabetic and Non Diabetic Patients
International Journal of Medical and Biomedical Studies
Background: Coronary artery disease (CAD) is one of the most important manifestation of diabetes mellitus. Objectives: To assess the extent of CAD in diabetic and non diabetic patients undergoing coronary angiography. Materials and Methods: 793 patients with suspected CAD, 202 diabetics and 591 non-diabetics were enrolled in the study. All patients underwent coronary angiography. Results: Normal coronaries were more common in non diabetic patients. Age at first presentation in diabetics was earlier as compared to non-diabetics. Diabetic female patients presented as early as third decade of life. Single vessel involvement was significantly more in non diabetics [40.27%] as compared to diabetic patients[19.8%][P= <0.001], while there were statistically no significant differences in double vessel disease in both groups [P= 0.572]. Triple vessel disease were more common in diabetic than non diabetic patients [P= <0.001]. Left main disease, left circumflex coronary artery disease,...