Profile of coronary artery disease cases in diabetics and non-diabetics:a comparative prospective study

Authors

  • Prabhat Pandey Department of Medicine, CM Medical College, Durg, Chhattisgarh, India
  • Rajendra Kumar Chandrakar Department of Medicine, CM Medical College, Durg, Chhattisgarh, India
  • Pavan Kumar Namewar Department of Medicine, CM Hospital, Bhilai, Dist. Durg, Chhattisgarh, India
  • Prashant Dobariya Department of Medicine, CM Hospital, Bhilai, Dist. Durg, Chhattisgarh, India
  • Pooja Pandey Department of Dermatology, AIIMS, Raipur, Chhattisgarh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20162498

Keywords:

Coronary artery disease, Diabetes, Non-diabetics

Abstract

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.

References

Mcgraw- Hill, Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, Loscalzo. Harrisons Principles of Internal Medicine. New Delhi, 17th Edition; 2008: 2275-2277.

Ramachandran A, Vishwanathan M, Mohan V, “Epidemiology of NIDDM in Indians”. JAPI. 1993;1:1-4.

Turner RC, Millns H, Neil HA. Risk Factors for Coronary Artery Disease in Non-insulin Dependent diabetes Mellitus: United Kingdom Prospective Diabetes Study (UKPDS:23). BMJ. 1998;316:823–8.

Nelson RG, Maurice L, Sievers. Low Incidence of Fatal Coronary Heart Disease in Pima Indians Despite High Prevalence of NIDDM. Circulation. 1990;81:987-95.

Mckeigue PM, Bela Shah, Marmot MG. Relation of Central Obesity and Insulin Resistance with High Diabetes Pervalence and Cardiovascular Risk in South Asians. The Lancet. 1991;337:382–6.

Singh RB, Niaz MA. Coronary Risk Factors in Indians. The Lancet. 1995;346:778-82.

Abbot RD, Donahue RP, Kannel WB. The Impact of Diabetes on Survival Following Myocardial Infaction in MensVs women. The Framingham Study. AMA. 1988;260(23):3456–60.

Siegel RD, Cupples A, Schaefer EJ. Lipoproteins, Apolipoproteins and Low (Density Lipoprotein Size among Diabetics in the Framingham Offspring Study. Metabolism. 1996;45(10):1267-72.

http://www.ndei.org/uploadedFiles/Common/NDEI/Treatment_Guidelines/ADA%202015%20Summary%20PDF.pdf. Accessed 10 March 2016.

https://www.nhlbi.nih.gov/files/docs/guidelines/express.pdf. Accessed 10 March 2016.

Kannel WB, Abbott RD. Incidence and Prognosis of Unrecongnised Myocardial Infarction: An Update on the Framingham study. N Engl J Med. 1984;311:1144-7.

Soler NG, Bennett M, Pentecost BL. Infarction in Diabetics “ Myocardial”. Q J Med. 1975;173:125-32.

Mak KH, Granger CB, Miller DP. Influence of Diabetes Mellitus on Clinical Outcome in the thrombolytic era of Acute Myocardial Infarction – GUSTO – 1 Investigations. J Am Coll Cardiol. 1997;30:171-9.

Turner RC, Millns H, Neil HAW. Risk Factors for Coronary Artery Disease in Non-insulin Dependent diabetes Mellitus: United Kingdom Prospective Diabetes Study (UKPDS:23). BMJ. 1998;316:823–8.

Barett C, Barbara A, Wingard L. Why is Diabetes mellitus a Stronger Risk Factor for Fatal Ischaemic Heart Disease in women than in Men” – The Rancho Bernardo Study. JAMA. 1991;265(5):627-31.

Seibaek M, Sloth C, Vallebo L, Hansen T, Urhammer SA, Burchardt H, et al. Glucose Tolerance Status and Severity of Coronary Artery Disease in Men Referred to Coronary Arteriography. Am Hert J. 1997;133:622-9.

Koskinen P, Manttar M, Manninen V. Coronary Heart Disease Incidence in NIDDM Patients in the Helsinki Heart Study. Diabetes Care. 1992;15(7):820–5.

Fontbonne A, Charles MA, Richard JL. Hyperinsulinaemia as a Predictor of Coronary Heart Disease Mortality in a Healthy population : The Paris Prospective Study, 15 year follow up. Diabetologia. 1991;34:356–61.

Downloads

Published

2016-12-29

Issue

Section

Original Research Articles