Libyan Journal of Medical Sciences

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 5  |  Issue : 3  |  Page : 125--127

Coronary angiographic characteristics of type 2 DM compared with nondiabetic patients in Benghazi-Libya. A cross-sectional study


Zaki Bettamer1, Abdelhadi H Elkadiki1, Khaled D Alsaeiti2,  
1 Department of Internal Medicine, Faculty of Medicine, Benghazi University, Benghazi, Libya
2 Department of Internal Medicine, Aljamhorya Hospital, Benghazi, Libya

Correspondence Address:
Dr. Khaled D Alsaeiti
Department of Internal Medicine, Aljamhorya Hospital, Benghazi
Libya

Abstract

Background/Aim: The absolute risk of death due to coronary artery disease (CAD) is two to five times higher in patients with diabetes than in those without diabetes regardless of the cholesterol concentration, and females with diabetes have the worst prognosis. The aim of the current study was to investigate the angiographic severity and extent of CAD in patients with Type 2 diabetes mellitus, compared with nondiabetic patients. Patients and Methods: A hospital-based retrospective cross-sectional study was performed on 340 patients who were diagnosed with CAD. The two groups were matched for age, gender, and other major risk factors. Data collected include demographic data, distribution, and extent of coronary artery involvement. Results: Three hundred and forty patients were included in the study, 175 of them (51.4%) were diabetics, and 165 (48.5%) were nondiabetics, comparing coronary angiographic results of both groups: One hundred and twenty-six patients (73%) of the diabetic patients have multivessel diseased (P = 0.003), 49 patients (27%) have a single-vessel diseased and none of them have a normal coronaries (0%). While for the nondiabetic patients 82 (50%) of them have a multivessel diseased, 63 patients (38%) have a single-vessel diseased, and 20 patients (12%) have normal coronaries. Conclusion: Multivessel disease with diffuse lesion is more prevalent among diabetic Libyan patients compared with nondiabetics. The affected vessels in diabetic patients are diffusely diseased more than nondiabetic.



How to cite this article:
Bettamer Z, Elkadiki AH, Alsaeiti KD. Coronary angiographic characteristics of type 2 DM compared with nondiabetic patients in Benghazi-Libya. A cross-sectional study.Libyan J Med Sci 2021;5:125-127


How to cite this URL:
Bettamer Z, Elkadiki AH, Alsaeiti KD. Coronary angiographic characteristics of type 2 DM compared with nondiabetic patients in Benghazi-Libya. A cross-sectional study. Libyan J Med Sci [serial online] 2021 [cited 2022 Jan 19 ];5:125-127
Available from: https://www.ljmsonline.com/text.asp?2021/5/3/125/328081


Full Text



 Introduction



Heart disease, particularly coronary artery disease (CAD) is a major cause of morbidity and mortality among patients with diabetes mellitus. Compared to individuals without diabetes, those with diabetes have a higher prevalence of CAD, a greater extent of coronary ischemia, and are more likely to have a myocardial infarction (MI), and silent myocardial ischemia.[1],[2]

While recent advances in the treatment of CAD have increased the survival of these patients, the absolute risk of death due to CAD is two to five times higher in patients with diabetes than in those without diabetes regardless of the cholesterol concentration, and females with diabetes have the worst prognosis. The relative risk of CAD is two- or three-fold higher in this population.[3],[4],[5] The aim of the current study was to investigate the severity and extent of CAD in consecutive patients with Type 2 diabetes mellitus, compared with those for matched nondiabetic patients, undergoing clinically indicated coronary angiography.

 Patients and Methods



A hospital-based retrospective cross-sectional study was performed on 340 patients who were diagnosed with CAD. The study was conducted between January 2018 and June 2020 at Benghazi Cardiac Center, Benghazi-Libya. One hundred and seventy-five patients of them were diabetics and 165 were nondiabetics, patients with CAD and known to have Type 2 diabetes were included in Group 1, and patients with CAD proved to be nondiabetics were included in Group 2. The diagnosis of diabetes mellitus was established if the patient was already known to be Type 2 diabetic, or first-time diabetic when the fasting plasma glucose levels were higher than 126 mg/dl according to the American Diabetes Association's guidelines 2017.[6]

The two groups were matched for age, gender, and other major risk factors. A valid and reliable data collection form was used to capture data contained in the medical records. In this form, the following criteria and clinical parameters were considered: patient demographic data (age, gender, ethnicity, and residence area), distribution, and extent of coronary artery involvement were assessed by visual measurement and quantum-dot cellular automata, using the segmental distribution method for coronary artery lesions and morphometric analysis of atherosclerotic lesion was done.

Inclusion criteria

All patients underwent elective coronary angiography with Type 2 diabetes mellitus. There were either symptomatic patients (chest pain and dyspnea) or those with previous MI or post angina. Asymptomatic and symptomatic patients with normal electrocardiogram, with normal or abnormal echocardiography findings (i.e. left ventricular dysfunction, hypokinesia) indicating ischemic heart disease, with positive exercise stress test or echocardiographic stress test.

Exclusion criteria

Patients with Type 1 diabetes or having impaired fasting glucose level presenting with CAD. (Fasting Plasma Glucose <126 mg/dl But >110 mg/dl, Post-Prandrial-Plasma Glucose 140–200 mg/dl). Moreover, patients <30 years old or with valvular and/or congenital heart disease were also excluded from the study.

Statistical analysis

The data were summarized using Microsoft Excel 2010 and then coded and processed on IBM compatible computers, using the Statistical Package for the Social Sciences (SPSS [22.0] SPSS; SPSS Inc. Chicago, IL, USA). Descriptive statistics of the different variables were presented either as frequencies and percentages or as means ± standard deviation. For statistical comparisons, independent samples Chi-square test was employed for testing the statistical significance of association between two discrete variables. Significant value is set up at P < 0.05.

 Results



A total of 340 patients were included in the study, 175 of them (51.4%) were diabetics, and 165 (48.5%) were nondiabetics; the demographic characters and risk factors of diabetics and nondiabetic patients are shown in [Table 1].{Table 1}

Comparing coronary angiographic results of both groups: One hundred and twenty-six patients (73%) of the diabetic patients have multivessel diseased (P = 0.003), 49 patients (27%) have a single-vessel diseased, and none of them have a normal coronaries (0%). While for the nondiabetic patients 82 (50%) of them have a multivessel diseased, 63 patients (38%) have a single-vessel diseased, and 20 patients (12%) have normal coronaries.

A total of 20 patients (11%) of the diabetic patients reported to have a left main disease compared to 15 patients (9%) of the nondiabetic group (P = 0.03).

LAD-related disease was reported among 159 patients (91%) of the diabetic group compared with 127 patients (77%) of the nondiabetic, while RCA lesions were reported among 116 patients (66%) and 79 patients (48%) of the diabetic and nondiabetic groups, respectively, on the other hand, 72 (41%) and 54 (33%) of diabetic and nondiabetic groups resulted in circumflex artery disease, respectively; details of coronary artery involvement are shown in [Table 2] and [Table 3].{Table 2}{Table 3}

 Discussion



In the present study, we have analyzed 340 patient files (on a basis of presence or absence of diabetes Type 2 diagnosis) for their results of elective coronary angiography. We matched our patients in the two groups for age, gender, as well as for some risk facts such as hypertension, and smoking history. The prevalence of multivessel disease was more prevalent among diabetic patients compared to nondiabetics (73% vs. 50%), respectively, while normal coronary arteries and single-vessel disease were more prevalent among nondiabetic patients (50% vs. 27%). Same results were reported by other studies, Raj et al.[7] reported that diabetic patients have a higher prevalence of three-vessel disease (32.78% vs. 26.19%) and lower prevalence of single-vessel disease (26.24% vs. 33.33%). Silva et al.[2] found higher prevalence of multivessel disease among diabetic patients (47% vs. 31%) and lower prevalence of single-vessel disease (18% vs. 32%). Same results were reported by Uddin et al.[8] 82% of diabetics had multivessel disease versus 68% of nondiabetics, while normal coronary arteries and single-vessel disease were more prevalent in nondiabetic patients (32% vs. 18%). Similar results were reported in Iraq,[9],[10] Brazil,[11] India,[12] and Pakistan.[13] Other studies from Albania,[14] and Italy,[15] revealed no significant difference.

 Conclusion



Multivessel disease with diffuse lesion is more prevalent among diabetic Libyan patients compared with nondiabetics. The affected vessels in diabetic patients are diffusely diseased more than nondiabetics.

Compliance with ethical principles

The study was conducted according to the Declaration of Helsinki 1975. The study was approved by the ethical committee of the Benghazi Medical Center. All the information was kept confidential, and no individual identifiers were collected.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Hammoud T,s Tanguay JF, Bourassa MG. Management of coronary artery disease: Therapeutic options in patients with diabetes. J Am Coll Cardiol 2000;36:355-65.
2Silva JA, Escobar A, Collins TJ, Ramee SR, White CJ. Unstable angina. A comparison of angioscopic findings between diabetic and nondiabetic patients. Circulation 1995;92:1731-6.
3Malmberg K, Yusuf S, Gerstein HC, Brown J, Zhao F, Hunt D, et al. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) registry. Circulation 2000;102:1014-9.
4Grimaldi A, Heurtier A. Epidemiology of cardio-vascular complications of diabetes. Diabetes Metab 1999;25 Suppl 3:12-20.
5Kannel WB, McGee DL. Diabetes and cardiovascular risk factors: The Framingham study. Circulation 1979;59:8-13.
6Armstrong C. ADA updates standards of medical care for patients with diabetes mellitus. Am Fam Physician 2017;95:40-3.
7Girdhar R, Kothari Y, Kamat AS, Raj RA, Koithara BJ. Coronary angiographic (CAG) findings between diabetic and non diabetic patients in coronary artery disease: A comparative study. J Med Sci Cl Res 2005;14:32-7.
8Uddin SN, Malik F, Bari MA. Siddiqui NI, Khan GK, Rahman S. et al. Angiographic severity and extent of coronary artery diseases in patients with type 2 diabetes mellitus. Mymentsingh Med J. 2005;14:32-37.
9Albarzani MA. Angiographic profile in diabetic and non-diabetic patients with coronary artery disease in the Cardiac Specialty Hospital–Cardiac Center, Erbil, Iraq. Zanco J Med Sci 2017;21:1701-7.
10Hussein MF. Clinical and angiographic findings in diabetic versus non-diabetic Iraqi patients with ischemic heart disease (a single center experience). IPMJ 2011;10:339-46.
11Sousa JM, Herrman JL, Teodoro M, Diogo S, Terceiro BB, Paola AA, et al. Comparison of coronary angiography findings in diabetic and non-diabetic women with non-ST-segment-elevation acute coronary syndrome. Arq Bras Cardiol 2006;86:150-5.
12Mahalle N, Garg MK, Naik SS, Kulkarni MV. Association of metabolic syndrome with severity of coronary artery disease. Indian J Endocrinol Metab 2014;18:708-14.
13Ahmed J, Rathi N, Alam MT, Baloch Z, Munaf A, Maheshwari B, et al. Acute myocardial infarction. Prof Med J 2015;22:996-1000.
14Zera E, Xinxo S, Lezha MJ, Ahmed J, Rathi N, Alam MT, et al. Comparison of in-hospital outcome of acute myocardial infarction in patients with vs. without diabetes mellitus in Durres population. Cardiol Angiol 2015;3:130-6.
15Andreini D, Pontone G, Bartorelli AL, Agostoni P, Mushtaq S, Antonioli L, et al. Comparison of the diagnostic performance of 64-slice computed tomography coronary angiography in diabetic and non-diabetic patients with suspected coronary artery disease. Cardiovasc Diabetol 2010;9:80.