Acute coronary syndromes in smokers: clinical and angiographic characteristics.

Smoking is a major and reversible risk factor for coronary artery disease. The present work aims to define the risk factors, angiographic and clinical characteristics and evolution of acute coronary syndromes in smokers. METHODS: We studied 521 consecutive patients with acute coronary syndrome admitted to the intensive care unit who underwent catheterization. We assessed the population in terms of risk factors, pathology (unstable angina or acute myocardial infarction), coronary morphology, left ventricular function, the need for intervention, evolution and complications over a one-year period. The characteristics of smokers were then compared with those of non-smokers. RESULTS: Of the 521 patients with acute coronary syndrome (391 men), 182 (35 %) were smokers. The smokers were younger than the non-smokers (56.3+/-9.5 versus 66.4 +/- 7.8; p < 0.001), were more frequently male (91 versus 66%; p < 0.001), and presented more risk factors (43% with 3 or more risk factors versus 17% in non-smokers; p < 0.001), more obesity (11 versus 5%; p < 0.01), and less diabetes (19 versus 37%; p < 0.001). Smokers presented greater prevalence of acute myocardial infarction (57 versus 40%; p < 0.001) and less unstable angina. Coronary morphology was not significantly different in smokers compared to non- smokers and left ventricular function after the aculte coronary syndrome was similar in both groups. Smokers less frequently underwent surgery during hospitalization (22% versus 35%; p < 0.01) but needed angioplasty as often as non-smokers (48% versus 16%; NS). Smokers presented more frequent complications (angina, heart failure, re-infarction or CABG) than non-smokers (26% versus 17%; p < 0.01), during the first year of follow-up. One-year mortality was similar in both groups. The results were not significantly different when adjusted for gender. CONCLUSIONS: On average, acute coronary syndrome occurred 10 years earlier in smokers than in non-smokers. The former generally presented more risk factors, lower prevalence of diabetes and higher of obesity, more myocardial infarctions and less unstable angina. After the acute coronary syndrome, at one year, smokers presented more complications than non-smokers but had similar mortality.     

GGT levels in type II diabetic patients with acute coronary syndrome (does diabetes have any effect on GGT levels in acute coronary syndrome?)

Elevated gamma-glutamyltransferase (GGT) level is independently correlated with conditions associated with increased atherosclerosis, such as obesity, elevated serum cholesterol, high blood pressure and myocardial infarction. It is demonstrated that serum GGT activity is an independent risk factor for myocardial infarction and cardiac death in patients with coronary artery disease. Diabetes is also a well-known cardiovascular risk factor and an equivalent of coronary artery disease. Although the relationship between GGT and coronary artery disease has been reported, there are limited data exploring the changes of GGT in acute coronary syndromes, especially in patients with diabetes. So, this study aimed to determine changes in GGT level in diabetic and non-diabetic acute coronary syndromes. This trial was carried out at Kosuyolu Cardiovascular Training and Research Hospital and Van Yuksek Ihtisas Hospital, Turkey. A total of 219 patients (177 men and 42 women) presenting with acute coronary syndrome) and 51 control subjects between September 2007 and September 2008 were included in the study. Serum γ-glutamyltransferase and serum lipoprotein levels were determined. The resuls indicated that serum GGT levels were higher in acute coronary syndrome patients compared with control. In subgroup analyses, there was no difference between diabetic and non-diabetic subgroups. There was also weak correlation between GGT and blood glucose levels. There was no correlation between GGT and serum lipoprotein levels. In conclusion, serum GGT levels were higher in acute coronary syndrome patients. In subgroup analyses, There was no difference between diabetic and non diabetic subgroup.     

Der Einfluss des Diabetes mellitus auf koronarchirurgische Eingriffe unter besonderer Berücksichtigung der linksventrikulären Funktion

BACKGROUND: Diabetes mellitus is not only an independent risk factor for the development of arteriosclerosis, but also a risk factor for the surgical and interventional treatment of coronary artery disease (CAD). PATIENTS AND METHODS: In 2003, a consecutive series of 2,142 patients underwent isolated coronary bypass grafting at the authors' institution, 567 of these suffering from diabetes mellitus. RESULTS: An analysis of the diabetic and nondiabetic patients revealed a more pronounced risk profile, a significantly reduced left ventricular function and a significantly poorer quality of the coronary arteries in the diabetic group. Perioperative mortality in both groups was not different. The incidence of wound infections, renal failure and neurologic complications was much higher in diabetic patients. CONCLUSION: From these findings it can be concluded that coronary artery bypass grafting in the current era is not associated with a higher perioperative mortality in diabetic patients despite their risk profile at baseline. The risk of wound infections and perioperative renal and neurologic complications is much higher in diabetic patients.     

The worse hospital outcome of diabetic patients is not explained by the severity of underlying coronary artery disease.

INTRODUCTION: Diabetes mellitus has a high prevalence in developed countries and is associated with high cardiovascular morbidity and mortality rates. In this study we evaluated in-hospital evolution of diabetic patients admitted to a cardiac care unit with acute coronary syndrome without ST segment elevation. METHODS: We analyzed a population of 176 consecutive patients, 36 (21%) with diabetes, admitted with chest pain at rest, elevated biological markers for myocardial necrosis and/or ST segment/T wave changes suggestive of myocardial ischemia. RESULTS: The groups were similar in terms of age, sex, presence of other risk factors for coronary artery disease (CAD), past history of CAD or myocardial revascularization. There were no differences between the groups with respect to extent of CAD, left ventricular function or blood levels of biological markers. The comparison between the two groups did not show any statistical difference concerning the following in-hospital events: non-Q wave MI, Q-wave MI, PTCA and death. On the other hand, the diabetic patients had a worse outcome in term of congestive heart failure (25% and 11%, p = 0.04), CABG (25% and 10%, p = 0.02) and combination of death, congestive heart failure and Q-wave MI (42% and 23%, p = 0.02). CONCLUSION: In spite of similar extent of CAD and similar left ventricular function, diabetes mellitus in patients with acute coronary syndrome without ST segment elevation identifies a higher-risk population with more complicated in-hospital outcome.     

Management and short-term outcome of diabetic patients hospitalized for acute myocardial infarction: results of a nationwide French survey

OBJECTIVES: To compare management and short-term outcome of diabetic and non-diabetic patients hospitalized for acute myocardial infarction. METHODS: This was a prospective epidemiological survey. All patients admitted in coronary care units in France in November 2000 for confirmed acute myocardial infarction were eligible to enter the study. RESULTS: Of the 2320 patients recruited from 369 centers, 487 were diabetic (21%). Compared to non-diabetic patients, diabetic patients were 5 years older, more often female, obese and hypertensive; they had more often a history of cardiovascular disease; they had a lower ejection fraction and worse Killip class. Reperfusion therapy was less frequent among diabetic patients (39% versus 51%; p=0.0001), as was the use of beta-blockers (61% versus 72%; p=0.0001), aspirin (83% versus 89%; p=0.0001) and statins (52% versus 60%; p=0.001) during hospitalization. Conversely, the use of ACE-inhibitors was more frequent (54% versus 44%; p=0.0001). 58% of diabetic patients received insulin during hospitalization. Twenty-eight-day mortality was 13.1% in diabetic patients and 7.0% in non-diabetic patients (risk ratio: 1.87; p=0.001). Diabetes remained associated with increased mortality after adjustment for relevant risk factors including age and ejection fraction (risk ratio: 1.51; p=0.07). In patients treated with antidiabetic drugs (chiefly sulfonylureas) before admission, 28-day mortality was 10.4% compared with 19.9% in diabetic patients on diet alone or untreated (p=0.005). CONCLUSION: Despite higher cardiovascular risk and worse prognosis, in-hospital management of diabetic patients with acute myocardial infarction remains sub-optimal. Patients previously treated with antidiabetic drugs including sulfonylureas had a better prognosis than untreated diabetic patients.     

糖尿病患者冠状动脉病变进展的分子机制

糖尿病已经成为动脉粥样硬化和冠心病最重要的危险因子。强化血糖控制降低了糖尿病患者心血管病和其他并发症的发生率,但是仍不能有效预防其并发症的发生。经皮冠状动脉介入治疗的不断成熟,药物洗脱支架和联合高效抗凝药的应用,使糖尿病患者从中受益,但是糖尿病患者术后靶病变重建、心源性死亡、心肌梗死的发生率仍明显高于非糖尿病患者。近年来关于糖尿病加速冠脉病变发生发展机制的研究有许多新的进展,现从分子机制方面加以阐述。     

Clinical predictors of left main coronary artery disease in high-risk patients with a first episode of non-ST-segment elevation acute coronary syndrome

INTRODUCTION AND OBJECTIVES: Risk stratification in non-ST-elevation acute coronary syndrome makes use of clinical variables that can identify patients at an increased risk of complications. Our objective was to identify clinical variables that predict significant stenosis (i.e., >50%) of the left main coronary artery in high-risk patients who have had a first episode of non-ST-elevation acute coronary syndrome but who do not have a history of coronary artery disease. METHODS: The study included 102 high-risk patients with no history of coronary artery disease who were admitted because of non-ST-elevation acute coronary syndrome. All underwent coronary angiography. Patients were divided into two groups: those with significant left main coronary artery stenosis (n=14) and those without (n=88). RESULTS: Univariate analysis showed that the variables significantly associated with left main coronary artery stenosis were age >65 years (57.1% vs 15.9%, P=.002), diabetes mellitus (71.4% vs 33.0%, P=.006), chronic renal failure (28.6% vs 5.7%, P=.019), left heart failure (71.4% vs 6.8%, P< .0001), cardiogenic shock (21.4% vs 1.1%, P=.008), and a low left ventricular ejection fraction at admission (49.9% [14.7%] vs 58.8% [9.9%], P=.044). In the multivariate analysis, the only significant independent predictor of left main coronary artery disease was left heart failure. CONCLUSIONS: The presence of left heart failure at initial assessment of high-risk patients with non-ST-elevation acute coronary syndrome but without a history of coronary artery disease could be a useful predictor of significant left main coronary artery disease.     

Major determinants of the carotid intima-media thickness in type 2 diabetic patients: age and body mass index

The present study has been designed to quantify and compare right and left carotid intima-media thicknesses (IMT) in type 2 diabetics and healthy controls. It was also intended to investigate the effects of various risk factors on the carotid IMT in these subjects. A total of 122 subjects; 70 patients with type 2 diabetes and 52 non-diabetic subjects as controls, were recruited for the study. Right and left common carotid artery stiffness indices were assessed with ultrasonography in both groups. Age, body mass index (BMI), duration of diabetes, cigarette smoking, lipid profile including lipoprotein a, Chlamydia pneumonia seropositivity, glycemic indices, fasting insulin levels, serum fibrinogen levels and presence of hypertension, coronary artery disease, degenerative complications of diabetes mellitus were all assessed in order to define their role as determinants of carotid artery IMT. The difference between the groups regarding mean carotid IMT was statistically significant for the left carotid arteries (p = 0.028) and borderline significance was found for the right carotid arteries (p = 0.055). Age has a very strong association with carotid IMT in diabetic patients (p < 0.0001) with univariate analysis. According to the results of multivariate analysis, age and BMI were found to be the most important independent determinants of carotid IMT for both sides. When age was excluded from the model, BMI and coronary artery disease were found to have strong association with IMT on the right (p = 0.0036 and 0.0249) and BMI was the only significant determinant for the left side (p = 0.0025). This study shows that carotid IMT is greater in diabetic subjects compared with healthy controls. For the diabetic subjects, age, BMI and presence of coronary heart disease have a strong influence on the atherosclerotic process of the carotid arteries.     

Prognostic value of coronary artery calcium screening in subjects with and without diabetes

OBJECTIVES: The study was done to determine the interaction of coronary artery calcium and diabetes mellitus for prediction of all-cause death. BACKGROUND: Diabetes is a strong risk factor for coronary artery disease (CAD) and is associated with an elevated overall mortality. Electron beam tomography (EBT) provides information on the presence of subclinical atherosclerosis and may be useful for risk stratification. METHODS: We followed 10,377 asymptomatic individuals (903 diabetic patients) referred for EBT imaging. Primary end point was all-cause mortality, and the average follow-up was 5.0 +/- 3.5 years. Cox proportional hazard models, with and without adjustment for other risk factors, were developed to predict all-cause mortality. RESULTS: Patients with diabetes had a higher prevalence of hypertension and smoking (p < 0.001) and were older. The average coronary calcium score (CCS) for subjects with and for those without diabetes was 281 +/- 567 and 119 +/- 341, respectively (p < 0.0001). Overall, the death rate was 3.5% and 2.0% for subjects with and without diabetes (p < 0.0001). In a risk-factor-adjusted model, there was a significant interaction of CCS with diabetes (p < 0.00001), indicating that, for every increase in CCS, there was a greater increase in mortality for diabetic than for nondiabetic subjects. However, patients suffering from diabetes with no coronary artery calcium demonstrated a survival similar to that of individuals without diabetes and no detectable calcium (98.8% and 99.4%, respectively, p = 0.5). CONCLUSIONS: Mortality from all causes is increased in asymptomatic patients with diabetes in proportion to the screening CCS. Nonetheless, subjects without coronary artery calcium have a low short-term risk of death even in the presence of diabetes mellitus.     

Diabetes mellitus and unstable coronary artery disease: improved clinical outcome of coronary artery stenting in an era of glycoprotein IIb/IIIa inhibitors and lipid-lowering therapy

OBJECTIVE: The short- and long-term clinical outcomes of coronary artery stenting in diabetic patients with unstable coronary artery disease were assessed and compared with a cohort of non-diabetic patients in the context of platelet glycoprotein IIb/IIIa inhibitors and lipid-lowering therapy. METHODS: The study population comprised 252 consecutive patients with unstable angina who underwent coronary artery stenting; of these 46 were diabetic and 206 were non-diabetic. In-hospital results and clinical outcome during follow-up (24 +/- 13 months, range 7-56 months) were obtained in all patients without major in-hospital complications. Survival curves and multivariate models for any late clinical event were reported. RESULTS: A high clinical success rate and no difference in in-hospital complications between the two groups of patients were observed. Complete revascularization rate was similar in diabetic and non-diabetic patients (48% compared with 52%). A greater proportion of diabetic than non-diabetic patients received IIb/IIIa inhibitors during the procedure and lipid-lowering drugs at hospital discharge (87% compared with 46%, P=0.001 and 83% compared with 61%, P=0.006 respectively). At 2-year clinical follow-up, the incidences of death and myocardial infarction were similar in both groups; the need for any revascularization was only slightly higher in diabetic patients (P=NS). Incomplete revascularization and multi-vessel disease were independent predictors of any revascularization. CONCLUSIONS: Coronary artery stenting combined with glycoprotein IIb/IIIa inhibitor infusion and long-term lipid-lowering therapy is an effective therapeutic strategy in diabetic patients with unstable coronary artery disease and is associated with good short- and long-term results, comparable to those observed in non-diabetic patients.     

Balloon coronary angioplasty and long-term survival of non-diabetic patients with isolated severe left anterior descending coronary artery disease.

Although long-term survival of diabetic patients with multivessel coronary disease has been reported to be better in those treated with bypass surgery than with coronary angioplasty, it is unclear if diabetic patients who undergo coronary angioplasty show better long-term survival than those treated medically. Between 1985 and 1994, 667 consecutive patients with isolated severe (> or = 90% diameter stenosis) proximal left anterior descending (LAD) coronary artery disease were divided into 4 groups according to the initial therapeutic choice and their diabetic status: of 225 diabetic patients, 104 were treated medically and 121 underwent coronary angioplasty; of 442 non-diabetic patients, 215 were treated medically and 227 underwent coronary angioplasty. The primary end-point of follow-up was death from any cause, and the secondary end-point was cardiac death. Cox's proportional hazard model was used to assess the relative risk of baseline variables. The mean follow-up interval was 6.5+/-3.0 years. The relative distribution of baseline parameters of medically treated patients to those treated with coronary angioplasty was identical in diabetic and non-diabetic patients. Although non-diabetic patients who underwent coronary angioplasty showed better long-term survival than those treated medically, this survival advantage was not observed in diabetic patients. After adjustment of parameters using Cox's proportional hazard model, age over 65 years, coronary angioplasty and low left ventricular ejection fraction were independent determinants of total death. Long-term survival in non-diabetic patients with severe LAD coronary artery disease is more favorable in patients treated with coronary angioplasty than those treated medically, but this advantage is overridden when the patients are diabetic.     

ST segment elevation in lead aVR and coronary artery lesions in patients with acute coronary syndrome

INTRODUCTION: Recently, the prognostic value of ST segment elevation in lead aVR in acute coronary syndrome (ACS) and its relationship with significant stenosis of the left main coronary artery (LMCAS) and three-vessel disease have been highlighted. AIM: Analysis of the relationship between ST segment elevation observed in aVR lead and angiographic severity of coronary artery disease in patients with ACS. METHODS: The study involved 134 patients with ACS, including 54 subjects with ST elevation in aVR (group A) and 80 patients without elevation of ST in the same lead (group B), aged 33-78 years, mean 59.9+/-9.7 years. The severity of coronary artery disease was compared between the two groups. The logistic regression model was used for the analysis of factors affecting ST segment in aVR, as well as LMCAS and three-vessel disease probability. RESULTS: In patients with ST elevation in aVR, three-vessel disease prevalence was two times higher (61.1% vs 35.0%; p <0.01), and LMCAS - three times higher (55.6% vs 17.5%; p <0.000001) than in those without ST elevation in aVR. Factors independently associated with ST elevation in aVR were LMCAS (OR 6.1; 95% CI 2.62-14.23; p <0.00005), ST segment elevation in V1 (OR 3.03; 95% CI 1.34-6.86; p <0.01) and diabetes (OR 2.89; 95% CI 1.17-7.15; p <0.05). The predictors of LMCAS were three-vessel disease and ST elevation in aVR, while the predictors of three-vessel disease were: LMCAS, diabetes, male gender and history of myocardial infarction. CONCLUSIONS: Elevation of the ST segment in aVR in the setting of acute coronary syndrome identifies patients with severe coronary artery disease. Only left main coronary artery disease, however, remains independently associated with ST segment elevation in aVR. Three-vessel disease and the left main coronary artery stenosis equivalent are not independent predictors of ST segment elevation in aVR of standard electrocardiograms recorded in patients with acute coronary syndrome.     

Influence of diabetes mellitus on the prognosis of non-ST-elevation acute coronary syndromes

Aim of studyAnalyze the influence of diabetes mellitus on the prognosis, at short and middle term of patients with non-ST-segment-elevation acute coronary syndrome.Patients and methodWe conducted a retrospective review of 308 consecutive medical records of patients admitted to the care unit of our department with a non-ST-segment-elevation acute coronary syndrome. One hundred and fifty-six patients were diabetics (group 1) and 152 were not (group 2). We compared the demographic, clinical, angiographic and therapeutic characteristics of the two groups and we analyzed the prognosis of diabetic and non-diabetic patients at short term (30 days) and at middle term (average: 28 months; extreme: 12 months, 72 months).ResultsThe mean age was similar into both groups (60.8 years). Diabetic patients were more often women (42.1% vs 23.1%) and presented a higher prevalence of systemic hypertension, dyslipidemia and family history of coronary artery disease. Smoking was more frequent in group 2. The rates of coronary angiography, percutaneous transluminal coronary angioplasty, and coronary bypass surgery were similar in the two groups. At 30 days, diabetic patients were at increased risk for acute heart failure (19.1% vs 6.4%) and for major cardiac events (12.5% vs 6.4%). A pejorative prognosis was also observed at middle term among diabetic patients. They were at greater risk for readmissions for non-ST-segment-elevation acute coronary syndrome (42% vs 25%), for major cardiac events (49.3% vs 31.6%) and for new revascularizations (17.3% vs 7.2%). In a Cox multivariate analysis, diabetes mellitus remains an independent risk factor for major cardiac events at middle term.ConclusionOur study confirms the pejorative prognosis of acute coronary syndromes without ST elevation at short and middle term in diabetic patients.     

Diabetes and complications after cardiac surgery: comparison with a non-diabetic population

Diabetes is a well-recognized independent risk factor for mortality due to coronary artery disease. When diabetic patients need cardiac surgery, either coronary-aortic by-pass (CABP) or valve operations (VO), the presence of diabetes represents an additional risk factor for these major surgical procedures. Because of controversial data on mortality rates and post-operative complications in diabetic patients, probably due to not exactly comparable groups of patients, this retrospective study aimed to compare two homogeneous populations, which were different only for the presence or absence of diabetes. We studied 700 patients undergoing cardiac surgery: 350 with and 350 without diabetes, mean age 62 ± 9 years (67% males); 441 underwent CABP and 259 VO. Apart from the diabetes, the two groups were strictly matched for age, body mass index, concomitant pathologies and smoking habits, except for previous neurological injuries (more frequent in diabetic patients), and for a slightly lower ejection fraction in the diabetic group. Intra- and post-operative complications or events were evaluated carefully: death, number staying in post-operative intensive care unit (ICU), renal, hepatic and respiratory complications, necessity for reoperation and hemotransfusions. Anesthesia and surgical procedures (including extra-coproreal circulation techniques) remained substantially unchanged over the period of recruitment of patients (1996–1998) and applied equally to both groups of patients. All diabetic patients were treated with insulin by using standard procedures in order to optimize metabolic control. Diabetic patients in our study, did not show higher rates of mortality in comparison with non-diabetic patients, but had more total neurological complications, more renal complications, a higher re-opening rate, more prolonged ICU stay, and they needed more blood transfusions. Diabetes remains an independent risk factor for these events even in a multivariate logistic regression model analysis. In the subgroup of diabetic patients who underwent CABP a higher rate of renal dysfunction, re-opening, need for hemotransfusions and prolonged ICU stay were confirmed. In the subgroup of diabetic patients undergoing VO we found a higher rate of renal dysfunction, reopening, prolonged ICU stay and major lung complications. In conclusion, diabetes does not seem to increase the mortality rates of cardiac surgery, but diabetic patients undergoing CABP have, on the basis of the relative risk evaluation, a 5-fold risk for renal complications, a 3.5-fold risk for neurological dysfunction, a double risk of being hemotransfused, reoperated or being kept 3 or more days in the ICU in comparison with non-diabetic patients. Moreover, diabetic patients undergoing VO have a 5-fold risk of being affected by major lung complications. Received: 2 February 1999 / Accepted in revised form: 19 May 1999     

Predictors of restenosis after implantation of 2.5 mm stents in small coronary arteries.

BACKGROUND: The results of stent implantation for small coronary disease have been inconclusive. The purpose of the present study was to evaluate the factors in predicting the risk of angiographic restenosis after 2.5-mm stent implantation for small coronary arteries. METHODS AND RESULTS: The study group comprised 134 consecutive patients who had a reference small coronary artery with diameter from 1.8 mm to 2.5 mm on quantitative coronary angiography and who had been successfully treated by stent implantation with a 2.5-mm stent. Of the 134 patients, 55 had angiographic restenosis (41%). The rate of target lesion revascularization was 32%. Diabetes mellitus, acute coronary syndrome, lesion length, bifurcation lesion, lower left ventricular ejection fraction (LVEF), stent strut, stent/artery ratio, and stent length were identified as predictors of restenosis by univariate analysis. Subsequent multivariate analysis revealed that lower LVEF (odds ratio (OR) 3.37, p=0.01), bifurcation lesion (OR 2.47, p=0.04), thicker stent strut (OR 2.30, p=0.04), and longer stent length (OR 1.05, p=0.02) were significant predictors of restenosis. CONCLUSIONS: Two pre-interventional factors (reduced left ventricular function and bifurcated lesion) and 2 procedure-related factors (thickness of stent strut and total stent length) were identified as predictors of restenosis. These factors should be taken into account when deciding on the percutaneous coronary intervention strategy for small coronary artery disease.     

Multiple risk factors in coronary artery disease patients with abnormal glucose tolerance

Two hundred twenty five anginal symptomatic patients (37-75 years) undergoing selective coronary angiography were studied to clarify the importance of risk factors for coronary artery disease (CAD). Serum lipids, apolipoproteins, fasting blood glucose, hemoglobin A1 and A1c, serum insulin levels, hypertension, smoking and obesity were examined as coronary risk factors in 64 newly diagnosed non-insulin dependent diabetic patients (60 +/- 1 (+/- SE)yr), 88 impaired glucose tolerant (IGT) patients (58 +/- 1 yr) and 73 non-diabetic patients (62 +/- 1 yr). Diabetic and IGT patients showed significantly higher coronary atherosclerosis indices than non-diabetic patients (p less than 0.05). In the diabetic and IGT groups, the plasma triglyceride concentrations were significantly higher in the patients with coronary atherosclerosis (CAS) than in either patients without CAS (p less than 0.05) or non-diabetic patients with CAS (p less than 0.05). The prevalence of hypertension in the diabetic patients with CAS was higher than in the non-diabetic patients with CAS. These data suggest that hypertriglyceridemia and hypertension might be important as risk factors in the development of coronary atherosclerosis in persons with an abnormal glucose tolerance.     

Coronary risk factors in newly diagnosed and previously diagnosed type 2 diabetic men with myocardial infarction

Risk factors for coronary artery disease in 131 known non-insulin-dependent (type 2) diabetic patients is compared to that in 115 newly diagnosed type 2 diabetic subjects and in 316 non-diabetic patients. The subjects, all Indian men aged 21-60 years, represent consecutive survivors of myocardial infarction and were investigated 3-4 months after their acute episode. A group of 524 healthy Indian men aged 21-60 years were included as controls. Significant differences in parameters measured were noted when all diabetic and non-diabetic patients were compared to the control group. Diabetic patients were older than the non-diabetic patients and with significantly higher frequency of hypertension and hypertriglyceridaemia, whilst smoking and family history of coronary artery disease were elicited more frequently in the non-diabetic patients. Mean concentrations of serum total cholesterol and lipoproteins in the diabetic and non-diabetic men were similar, whereas serum triglyceride concentrations were significantly higher in the diabetic patients. Newly diagnosed and known diabetic patients did not differ with respect to the risk factors examined. Clusters of various combinations of hypertension, obesity, hypertriglyceridaemia and low HDL-cholesterol values were encountered more frequently in diabetic patients when compared to non-diabetic patients, whilst no significant differences were observed when the two groups of diabetic subjects were compared. In conclusion, this study has demonstrated that in men with myocardial infarction there are significant differences between diabetic and non-diabetic patients with respect to certain risk factors. However, newly diagnosed diabetic men have similar risk profiles to their known diabetic counterparts.     

代谢综合征对糖尿病和非糖尿病患者冠状动脉血管病变的影响

目的:已有研究显示,代谢综合征(MS)和冠心病(CAD)的关系密切,本研究旨在探讨MS对糖尿病或非糖尿病患者冠状动脉病变狭窄程度的影响。方法:选择2008年3月至2010年9月,在北京安贞医院特需医疗科住院,行冠状动脉造影的634例患者。根据冠状动脉造影结果进行冠状动脉狭窄程度的评估,按冠状动脉病变支数分为单支病变、双支病变和多支病变。根据患者有代谢综合征指标的数目分成4组(0/1,2,3,4/5),比较各组对糖尿病或非糖尿病患者的冠状动脉病变情况的影响。结果:①MS患者(394例)与无MS患者比较(240例),CAD发病率增高(61.9%vs.30.8%,P<0.001),多支病变发病率增高(35.0%vs.15.0%,P<0.001),急性冠状动脉综合征发病率增高(50.0%vs.26.6%,P<0.001)。②非糖尿病组患者冠状动脉积分(冠状动脉病变程度)随着MS指标数目的增加而增加,差异有统计学意义(P<0.001);而在糖尿病组冠状动脉病变程度与MS指标数目差异无统计学意义(P>0.05)。结论:在非糖尿病组患者中随着合并MS指标数目增加冠状动脉病变的严重程度、冠心病例数、多支血管病变例数增加。而在糖尿病组患者中这种作用被糖尿病对冠状动脉的影响而掩盖。     

2型糖尿病与冠状动脉病变程度的相关性及特点分析

目的探讨2型糖尿病患者冠心病发病特点及与冠状动脉病变程度的相天性分析。方法选择2007年4月至2010年5月行择期冠脉介入治疗的本院2型糖尿病患者124例,同时选择2008年4月至2010年5月所有行择期行冠脉介入治疗的非糖尿病患者680例作为对照组。结果糖尿病组的124例病患中．人均冠脉病变1．98处（246／124）,非糖尿病组680例人均冠脉病变0.45（305／680）处。2型糖尿病组冠心病发病率、发生急性心肌梗死及陈旧性心梗均是非糖尿病组的2倍多．糖尿病组左主十病变比例高于非糖尿病组（P〈0．05）,完全或次全闭塞、分又处病变及弥漫性病变明显高于非糖尿病组（P〈0．05）,非糖尿病组以单支病变、双支病变为主,而糖尿病组以三支病变为主,两组间差异均有统计学意义。结论2型糖尿病的存在显著加重冠状动脉病变程度,冠状动脉的损害呈现弥漫性损害,发生心肌梗死事件多。有效地控制糖代谢紊乱．早期诊断及规范治疗,在干预冠状动脉粥样硬化发生和发展中具有重要意义。     

Chronic inflammation in patients with acute coronary syndrome and chronic kidney disease

Chronic kidney disease is a worldwide growing problem in public health. It is a risk factor for complications in patients with acute coronary syndrome (ACS). Diabetes, hypertension (hypertrophy and left ventricular failure), impaired fibrinolysis and coagulation processes, as well as the rapid development of atherosclerosis (partly associated with chronic inflammation) are responsible for higher prevalence of cardiovascular diseases in patients with chronic kidney disease. Inflammatory process of unknown aetiology belongs to the so-called non-traditional risk factors in development of cardiovascular system diseases. It is thought that this process is responsible for adverse remodelling of atherosclerosis plaque and its instability which causes plaque rupture and as a result a coronary syndrome occurrence. Important inflammatory mediators, which take part in pathogenesis of ACS, are acute phase proteins such as: C-reactive protein, adhesion molecules VCAM-1, ICAM-1, selectins, plasma amyloid A, metalloproteinases, interleukins-1 and -6, tumour necrosis factor-a and vascular endothelial growth factor.