Prevalence of significant coronary heart disease in valvular heart disease in Indian patients

Records of 326 patients were analysed to determine the prevalence of coronary heart disease (CHD) in patients with valvular heart disease (VHD) and to identify the group in whom coronary arteriography is essential. Significant CHD (60% or more luminal narrowing) was found in 7 per cent of cases, and its prevalence was 3 per cent in mitral, 10 per cent in aortic, and 6 per cent in combined mitral and aortic valve disease. Angina was present in 14 per cent of patients with mitral, 39 per cent with aortic, and 21 per cent with combined mitral and aortic valve disease. Seventy-three per cent of patients with CHD had angina whereas only 19 per cent with angina had CHD. The prevalence of CHD was higher in patients above 50 years (13%) and in males (98%) as compared to those below 50 years (3%) and females (none). We conclude that the prevalence of CHD is low in our patients with VHD. Routine coronary arteriography is recommended only in males over the age of 50 years.     

Prevalence of coronary heart disease in Pakistani patients suffering from maturity onset diabetes mellitus

In a group of 500 ambulant Pakistani patients suffering from diabetes mellitus, electrocardiographic evidence of coronary heart disease was present in 45 (9%). The frequency was higher in the males (12.1%) as compared to females (7.2%). The male diabetics with coronary heart disease had significantly high mean serum cholesterol values as compared to those without it. A positive family history of ischaemic heart disease, and the presence of small vessel disease as well as hypertension were more frequently associated with coronary heart disease. The overall frequency of hypertension was 21.2 per cent in this group of diabetics.     

Prevalence of undetected diabetes mellitus in invasive and interventional cardiology. Silent diabetes in the catheterization laboratory

In most randomized controlled trials on revascularization therapy for patients with ischemic coronary artery disease (CAD), the diabetes prevalence ranges between 15% and 35%. However, the true prevalence of diabetes is probably considerably underestimated in these trials. The European heart survey diabetes and the heart published in 2004 supplied strong evidence that there are many additional cases of undetected prediabetics and diabetics in any cardiology patient cohort. The long-term outcome of newly detected diabetics was found to be comparable to patients with already known diabetes mellitus. With this in mind, the Dresden silent diabetes study investigated the prevalence of undetected diabetes mellitus by oral glucose tolerance testing (OGTT) and comparative HbA1c sampling in 1,015 patients admitted for coronary angiography. Patients with known diabetes were excluded from the study.According to the OGTT only 513 patients (51%) were classified with normal glucose tolerance (NGT), 10 (1%) with isolated impaired fasting glucose (IFG), 349 (34%) with impaired glucose tolerance (IGT) and 143 (14%) were diagnosed with newly detected diabetes mellitus (DM). According to the HbA1c measurements 588 patients (58%) were classified as normal, 385 (38%) as borderline and only 42 (4%) were diagnosed with diabetes (DM). There was a significant correlation between the extent of CAD and glycemic status as defined by the OGTT. The number of patients with IGT and diabetes increased with the extent of CAD (IGT group p<0.001, diabetes group p=0.01). However, no such correlation was observed when glycemic status was defined by HbA1c testing.Based on these results an OGTT should be routinely performed in patients with known or suspected coronary artery disease undergoing coronary angiography for diagnosis of diabetes, as HbA1c measurements alone appear to miss a substantial proportion of patients. These findings are of high clinical relevance with regard to optimal coronary revascularization procedure chosen in catheterization laboratories, preferably drug-eluting stents in cases of diabetes mellitus or newly detected diabetes mellitus and preferably coronary bypass surgery in diabetics with multi-vessel disease and high SYNTAX scores.     

Cardiovascular risk factors in the elderly: the Tehran Lipid and Glucose Study

BACKGROUND: Coronary artery disease is becoming more prevalent in developing countries, particularly in urban areas. Because the proportion of elderly individuals in the population is on the rise, this study was conducted to determine the prevalence of cardiovascular risk factors among the Tehran urban elderly population. DESIGN AND METHODS: Among 15,005 urban individuals of 3 years old and over who had been chosen in a cross-sectional phase of a longitudinal study in Tehran, there were 1,799 people aged 60 years and over. The prevalence and distribution of high blood pressure, cigarette smoking, dyslipoproteinemia, diabetes mellitus and obesity were determined in this population. Dietary intake was assessed in a subsidiary of 54 people by means of two 24 h dietary recalls. RESULTS: The percentage of women with two or more cardiovascular disease risk factors was significantly greater than in men (74% compared with 53%, P < 0.001). One fourth of men and 55% of women had high serum cholesterol levels (>/=240 mg/dl). The prevalence of diabetes mellitus and impaired glucose tolerance was 24% and 21% in men and 29% and 20% in women, respectively. The prevalence of obesity (body mass index >/=30 kg/m(2)) was 15% for men and 36% for women. Fifty-five per cent of men and 94% of women had high waist-to-hip ratios (>0.95 in men and >0.8 in women). The mean percentage values of energy intake derived from carbohydrate, protein and fat were 60.5 +/- 8.0, 11.5 +/- 2.0 and 27.8 +/- 8.9, respectively. CONCLUSIONS: The prevalence of cardiovascular risk factors among the Tehran urban elderly population is high. Some efforts should be made to reverse the recent trend towards increasing age-related mortality and morbidity rates of coronary heart disease.     

冠心病合并糖代谢异常分析

目的探讨冠心病患者合并糖代谢异常的构成比变化趋势。方法回顾性分析1997、2002、2007年广东省心血管病研究所心内科住院的冠心病(2951例)合并糖代谢异常患者457例的临床资料,以上述3年的病案进行统计学处理,构成比标准化依据国际卫生组织人口构成。结果在内科住院的冠心病病人中,合并空腹血糖受损、糖耐量异常、2型糖尿病较1997年呈上升趋势;1997、2002、2007年的构成比分别为3.8%、16.5%、和10.8%。结论冠心病合并糖代谢异常越来越常见,在冠心病的二级预防中应高度重视糖代谢异常发生的防治。     

Incidence,prevalence and coronary heart disease risk level in known Type 2 diabetes: a sentinel practice network study in the Basque Country,Spain

Aims/hypothesis The aim of this study was to determine the incidence, prevalence and coronary heart disease risk in patients with known Type 2 (non-insulin-dependent) diabetes mellitus in a Basque Country sentinel practice network study.Methods During the year 2000 we did a survey among sentinel practitioners who registered information about previously and newly diagnosed Type 2 diabetic patients older than 24 years of age. We studied 65,651 people attending a primary care service in the Basque Country Health Service-Osakidetza. We collected information about diabetic complications and cardiovascular risk factors and measured the coronary heart disease risk in these patients.Results In the year 2000, the standardized cumulative incidence and prevalence of known Type 2 diabetes were 5.0 per 1000 (CI 95%: 4.9–5.1) and 4.6% (CI 95%: 4.5–4.7) respectively. Macroangiopathy was the most frequent complication both in the newly diagnosed (21.6%) and previously known Type 2 diabetic patients (33%). Total cholesterol 5.17 mmol/l and LDL cholesterol 2.58 mmol/l were found in 75% and 90% of newly diagnosed and 65% and 85% of previously diagnosed Type 2 diabetic patients respectively. Of the Type 2 diabetic patients 42% were obese and 80% had high blood pressure. More than 55% of the men compared with 44% of the women with Type 2 diabetes had high or very high risk of coronary heart disease (p<0.05).Conclusion/interpretation We report new epidemiological data on known Type 2 diabetes in the Basque Country. These patients have a high frequency of cardiovascular risk factors causing a high coronary heart disease risk.Abbreviations WHO MSVDD Word Health Organization Multinational Study of Vascular Disease in Diabetes - UKPDS United Kingdom Prospective Diabetes Study - MRFIT Multiple Risk Factor Intervention TrialThe authors wrote this article on behalf of and with the assistance of the Basque Country Sentinel Practice Surveillance Network: see acknowledgements for list of investigators     

Association of elevated lipoprotein(a) levels and coronary heart disease in NIDDM patients. Relationship with apolipoprotein(a) phenotypes

Summary Non-insulin-dependent diabetes mellitus (NIDDM) is a strong and independent risk factor for coronary heart disease. We assessed the potential relationship between plasma Lp(a) levels, apo(a) phenotypes and coronary heart disease in a population of NIDDM patients. Seventy-one patients with coronary heart disease, who previously have had transmural myocardial infarction, or significant stenosis on coronary angiography, or positive myocardial thallium scintigraphy, or in combination, were compared with 67 patients without coronary heart disease, who tested negatively upon either coronary angiography, myocardial thallium scintigraphy or a maximal exercise test. The prevalence of plasma Lp(a) levels elevated above the threshold for increased cardiovascular risk (>0.30 g/l) was significantly higher (p=0.005) in patients with coronary heart disease (33.8%) compared to the control group (13.4%). The relative risk (odds ratio) of coronary heart disease among patients with high Lp(a) concentrations was 3.1 (95% confidence interval, 1.31–7.34;p=0.01). The overall frequency distribution of apo(a) phenotypes differed significantly between the two groups (p=0.043). However, the frequency of apo(a) isoforms of low apparent molecular mass (700 kDa) was of borderline significance (p=0.067) between patients with or without coronary heart disease (29.6% and 16.4%, respectively). In this Caucasian population of NIDDM patients, elevated Lp(a) levels were associated with coronary heart disease, an association which was partially accounted for by the higher frequency of apo(a) isoforms of small size. In multivariate analyses, elevated levels of Lp(a) were independently associated with coronary heart disease (odds ratio 3.48, p=0.0233).Abbreviations NIDDM Non-insulin-dependent diabetes mellitus - IDDM insulin-dependent diabetes mellitus - CHD coronary heart disease - Lp(a) lipoprotein(a) - apo(a) apolipoprotein(a) - apoB apolipoprotein B - HMGCoA reductase hydroxymethylglutaryl coenzyme A reductase     

糖尿病合并冠心病的研究现状和治疗

糖尿病的患病率正逐年增加,冠心病是其最常见的合并症或并发症,二者的共同存在极大地增加了患者相关事件的风险.目前,欧洲心脏病学会(ESC)和欧洲糖尿病学会(EASD)以及美国糖尿病协会(ADA)发布了糖尿病及其合并症治疗的新指南.本文结合目前国际上新近的研究结果与上述指南,对糖尿病合并冠心病的研究现状及治疗作一些相关的介绍.     

北京市丰台区社区居民2011年冠心病流行病学调查分析

调查北京市丰台区冠心病流行病学特征和相关危险因素,为冠心病的一级和二级预防提供指导和依据。方法:随机抽取丰台3个社区的居民,调查冠心病、高血压、糖尿病、高脂血症等的发生率,探讨冠心病的危险因素。结果:本次应调查6882例,实查6842例,有效应答率为99.42%,发现277例冠心病患者,患病率为4.05%。Logistic多因素分析显示冠心病与年龄、糖尿病、高脂血症、饮酒和BMI相关(β=2.198~4.765,P<0.05~<0.001)。结论:老年人、糖尿病、高脂血症、饮酒和肥胖是冠心病的危险因素,应加强对这些危险因素的预防和矫正,降低冠心病的患病率和改善其预后。     

The vitamin D receptor gene variant is associated with the prevalence of type 2 diabetes mellitus and coronary artery disease.

AIMS: Vitamin D can influence lipolysis and insulin secretion. A common genetic polymorphism of the vitamin D receptor, which has been found to be associated with bone mineral density, has also been reported to be associated with insulin-dependent diabetes mellitus. To test the influence of the vitamin D receptor polymorphism on the prevalence of Type 2 diabetes mellitus and coronary artery disease we studied a population of high-risk patients, who were referred to our clinic for diagnostic coronary angiography. METHODS: A total of 293 patients considered at high risk for coronary artery disease because of angina pectoris and known hypercholesterolaemia underwent diagnostic coronary angiography. The BsmI vitamin D receptor polymorphism was analysed by polymerase chain reaction. RESULTS: Prevalence of Type 2 diabetes mellitus and coronary artery disease was gradually dependent on the number of B alleles (BB 28%, Bb 13%, bb 8% for Type 2 diabetes mellitus, P = 0.002; BB 88% Bb 72%, bb 66% coronary artery disease, P = 0.01). Patients with the BB genotype had an odds ratio of 3.64 (95% confidence interval 1.53-8.55, P = 0.002) to have Type 2 diabetes mellitus compared with patients with the bb genotype. CONCLUSIONS: The genotype of the vitamin D receptor polymorphism determines the prevalence of Type 2 diabetes mellitus and coronary artery disease in a high-risk cohort population.     

Coronary artery disease in young patients: arteriographic and clinical review of 40 cases aged 35 and under

Coronary arteriography was performed in 60 patients aged 35 or less with suggested coronary artery disease (CAD). Twenty patients (Group 1) had normal coronary arteries and 40 patients (Group 2) had one or more obstructive lesions. The left anterior descending artery was commonly involved followed by the right coronary and left circumflex arteries. The right coronary artery was most commonly completely obstructed. Single-vessel disease (50 per cent or greater obstruction) was found in 60 per cent of the patients, an incidence that is considerably higher than in studies of older patients. A total of 1.6 diseased vessels per patient was present. A hyperlipoproteinemia (HLP) was found in 68 per cent of Group 2 patients. Patients in Group 2 with an HLP had significantly more CAD than Group 2 patients with normal lipoproteins. The incidence of the following clinical features were not significantly different in Groups 1 and 2: typical angina, atypical angina, positive family history, smoking, hypertension, obesity, abnormal electrocardiogram, positive treadmill test, HLP, and diabetes mellitus. A fourth heart sound and a history of a myocardial infarction were significantly common in Group 2. Since almost all of the previously reported cases of myocardial infarction with normal coronary arteries have occurred in young patients, history of a myocardial infarction does not assure the presence of obstructive coronary artery lesions. It is suggested that coronary arteriography is a justifiable procedure in a young patient who presents with a clinical picture that is either compatible with or cannot be clearly distinguished from CAD.     

Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization

BACKGROUND: Chronic kidney disease is the primary cause of end-stage renal disease in the United States. The purpose of this study was to understand the natural history of chronic kidney disease with regard to progression to renal replacement therapy (transplant or dialysis) and death in a representative patient population. METHODS: In 1996 we identified 27 998 patients in our health plan who had estimated glomerular filtration rates of less than 90 mL/min per 1.73 m(2) on 2 separate measurements at least 90 days apart. We followed up patients from the index date of the first glomerular filtration rates of less than 90 mL/min per 1.73 m(2) until renal replacement therapy, death, disenrollment from the health plan, or June 30, 2001. We extracted from the computerized medical records the prevalence of the following comorbidities at the index date and end point: hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, hyperlipidemia, and renal anemia. RESULTS: Our data showed that the rate of renal replacement therapy over the 5-year observation period was 1.1%, 1.3%, and 19.9%, respectively, for the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) stages 2, 3, and 4, but that the mortality rate was 19.5%, 24.3%, and 45.7%. Thus, death was far more common than dialysis at all stages. In addition, congestive heart failure, coronary artery disease, diabetes, and anemia were more prevalent in the patients who died but hypertension prevalence was similar across all stages. CONCLUSION: Our data suggest that efforts to reduce mortality in this population should be focused on treatment and prevention of coronary artery disease, congestive heart failure, diabetes mellitus, and anemia.     

Pr?valenz unentdeckter Glukosestoffwechselst?rungen in der invasiven und interventionellen Kardiologie

In most randomized controlled trials on revascularization therapy for patients with ischemic coronary artery disease (CAD), the diabetes prevalence ranges between 15% and 35%. However, the true prevalence of diabetes is probably considerably underestimated in these trials. The European heart survey diabetes and the heart published in 2004 supplied strong evidence that there are many additional cases of undetected prediabetics and diabetics in any cardiology patient cohort. The long-term outcome of newly detected diabetics was found to be comparable to patients with already known diabetes mellitus. With this in mind, the Dresden silent diabetes study investigated the prevalence of undetected diabetes mellitus by oral glucose tolerance testing (OGTT) and comparative HbA1c sampling in 1,015 patients admitted for coronary angiography. Patients with known diabetes were excluded from the study. According to the OGTT only 513 patients (51%) were classified with normal glucose tolerance (NGT), 10 (1%) with isolated impaired fasting glucose (IFG), 349 (34%) with impaired glucose tolerance (IGT) and 143 (14%) were diagnosed with newly detected diabetes mellitus (DM). According to the HbA1c measurements 588 patients (58%) were classified as normal, 385 (38%) as borderline and only 42 (4%) were diagnosed with diabetes (DM). There was a significant correlation between the extent of CAD and glycemic status as defined by the OGTT. The number of patients with IGT and diabetes increased with the extent of CAD (IGT group p<0.001, diabetes group p=0.01). However, no such correlation was observed when glycemic status was defined by HbA1c testing. Based on these results an OGTT should be routinely performed in patients with known or suspected coronary artery disease undergoing coronary angiography for diagnosis of diabetes, as HbA1c measurements alone appear to miss a substantial proportion of patients. These findings are of high clinical relevance with regard to optimal coronary revascularization procedure chosen in catheterization laboratories, preferably drug-eluting stents in cases of diabetes mellitus or newly detected diabetes mellitus and preferably coronary bypass surgery in diabetics with multi-vessel disease and high SYNTAX scores.     

Ethnic Differences in the Incidence of Lower Extremity Amputation Secondary to Diabetes Mellitus

Patients of Asian ethnic origin with diabetes mellitus living in the United Kingdom (UK) have been shown to have a higher prevalence of coronary heart disease and renal disease. Little is known about the incidence of lower extremity amputation in this racial group. The incidence of lower extremity amputation was estimated for patients of Asian ethnic origin and White Caucasians with diabetes mellitus in the county of Leicestershire from 1980 to 1985. The age and sex-adjusted incidence rate of lower extremity amputation for the estimated population of patients with diabetes mellitus in patients of Asian ethnic origin was 3.4 (95% CI, 1.1–10.7) cases per 10000 patients year^?1, compared to 14.2 (12.6–15.9) in White Caucasians. Similarly, a lower incidence rate of lower extremity amputation was recorded in patients of Asian ethnic origin without diabetes mellitus (0.4 (0.2-0.6) vs 1.5 (1.4 to 1.6) cases per 10000 persons year^?1). These findings contrast markedly with the high rates of coronary heart disease and renal disease previously reported in patients of Asian ethnic origin residing in the UK.     

Coronary artery disease in young women and men with long-standing insulin-dependent diabetes

The prevalence and predictors of coronary artery disease were examined in people aged 40 years and younger with insulin-dependent diabetes mellitus. Analysis was performed on those who presented between 1999 and 2003 for kidney and/or pancreas transplant at the University of Minnesota, as all patients who have diabetes mellitus are required to have perioperative cardiology evaluation. The mean age was 33.5 +/- 4.4 years for 88 subjects, all had insulin-dependent diabetes mellitus, and 33% were dialysis dependent. Severe coronary artery disease was found in 18.2% of women and in 24.2% of men. Three-vessel coronary artery disease trended less in women (9.1%) compared with men (12.1%). Multivariate predictors for severe and 3-vessel coronary artery disease included prior coronary artery disease, hypertension duration, and ST-T wave changes on electrocardiogram. Coronary artery disease is twice as high as expected in young woman. Studies on early management for atherosclerosis are warranted in this high-risk population.     

老年2型糖尿病伴冠心病患者冠状动脉病变的临床和影像特点

为了观察老年 2型糖尿病伴冠心病患者冠状动脉病变的临床和影像学特点 ,选择 133例经冠状动脉造影确诊的冠心病患者 ,按是否合并 2型糖尿病分为两组 ,进行临床及影像学对照分析 ,结果发现老年冠心病伴 2型糖尿病患者甘油三酯高、高密度脂蛋白胆固醇低、左室射血分数低 ,冠状动脉病变以 3支血管病变及左主干病变多 ,室壁运动障碍发生率高 ,但侧枝循环丰富。Logistic回归分析显示年龄、高甘油三酯和低高密度脂蛋白胆固醇为独立危险因素。提示老年 2型糖尿病伴冠心病患者冠状动脉病变以 3支血管病变及左主干病变为主 ,高龄、高甘油三酯和低高密度脂蛋白胆固醇对老年冠心病伴 2型糖尿病患者的冠状动脉病变程度具有重要作用     

Coronary flow reserve abnormalities in patients with diabetes mellitus who have end-stage renal disease and normal epicardial coronary arteries

Background

Diabetic nephropathy is associated with increased cardiovascular events. Coronary atherosclerosis is responsible for many of these events, but other mechanisms such as impaired flow reserve may be involved. The purpose of this study was to define the prevalence and mechanism of abnormal coronary velocity reserve (CVR) in patients with diabetes mellitus who have nephropathy and a normal coronary artery.

Methods

Patients undergoing catheterization for clinical purposes were enrolled. CVR was measured with a Doppler ultrasound scanning wire in a normal coronary in 32 patients without diabetes mellitus, 11 patients with diabetes mellitus who did not have renal failure, and 21 patients with diabetes mellitus who had nephropathy. A CVR <2.0 was considered to be abnormal.

Results

Patients with diabetes mellitus who had renal failure had a higher incidence of hypertension and left ventricular hypertrophy. The average peak velocity (APV) at baseline was higher in patients with diabetes mellitus who had renal failure. At peak hyperemia, APV increased in all 3 groups, with no difference between groups. The mean CVR for patients without diabetes was 2.8 ± 0.8 and was not different from that in patients with diabetes mellitus who did not have renal failure (2.7 ± 0.7), but was lower than that in patients with diabetes mellitus who had renal failure (1.6 ± 0.5; P < 0.001). Abnormal CVR was observed in 9% of patients without diabetes mellitus, 18% of patients with diabetes mellitus who did not have renal failure, and 57% of patients with diabetes mellitus who had renal failure, and abnormal CVR was caused by an elevation of baseline APV in 66% of these cases. The baseline heart rate and the presence of diabetes mellitus with renal failure were independent predictors of abnormal CVR by multivariable analysis.

Conclusions

Patients with diabetic nephropathy have abnormalities in CVR in the absence of angiographically evident coronary disease.     

颈动脉超声在诊断冠心病合并2型糖尿病中的应用价值

目的探讨颈动脉超声在冠心病合并2型糖尿病中的应用价值。方法将研究对象分为合并2型糖尿病和不合并2型糖尿病的冠心病组，超声观察颈动脉血流参数、内中膜厚度（IMT）及斑块指数（PI），并与冠状动脉造影结果对照。结果与单纯冠心病患者相比，合并2型糖尿病的冠心病患者颈动脉内径和血管阻力指数均增加（P〈0.05），IMT及PI随冠状动脉造影病变程度的增加而显著增加（P〈0．05）。结论颈动脉超声可以间接判断冠心病合并2型糖尿病患者冠状动脉血管病变的严重程度，可作为诊断合并2型糖尿病的冠心病的一项辅助检查方法。     

Diabetes mellitus in older African-Americans, Hispanics, and whites in an academic hospital-based geriatrics practice.

BACKGROUND: Diabetes mellitus is a risk factor for target-organ damage/clinical cardiovascular disease in older persons. DESIGN: A retrospective analysis was performed of charts from all older persons (506 men and 1497 women, mean age 80 +/- 8 years) seen during the period from 1 January 1998 to October 1998 at an academic hospital-based geriatrics practice, to investigate the prevalence of diabetes mellitus, and the prevalence, in patients with diabetes, of target-organ damage/clinical cardiovascular disease, hypertension, hypertension or dyslipidaemia, obesity, the drugs used to treat diabetes, and poor glycaemic control. RESULTS: Diabetes mellitus occurred in 127 of 1150 whites (11%), in 93 of 444 African-Americans (21%), in 111 of 381 Hispanics (29%), and in four of 28 Asians (14%) (P < 0.001 comparing Hispanics with whites and comparing African-Americans with whites; P < 0.01 comparing Hispanics with African-Americans). Of 335 patients with diabetes, 146 (44%) had coronary disease, 94 (28%) had stroke or transient cerebral ischaemic attack, 86 (26%) had peripheral arterial disease, 65 (19%) had heart failure, 107 (32%) had nephropathy, 71 (21%) had retinopathy, 47 (14%) had neuropathy, 284 (85%) had target-organ damage/clinical cardiovascular disease, 252 (75%) had hypertension, 300 (90%) had hypertension or dyslipidaemia, and 152 (45%) had obesity. The prevalence of stroke or transient cerebral ischaemic attack was greater in older African-Americans with diabetes mellitus than in older whites with diabetes mellitus (P < 0.02). The prevalence of diabetic nephropathy and of target-organ damage/clinical cardiovascular disease was greater in older African-Americans with diabetes mellitus than in older whites (P < 0.02) and Hispanics (P < 0.05) with diabetes mellitus. Increased concentrations of glycosylated haemoglobin (> 7%) occurred in 28 of 86 African-Americans (33%), in 69 of 104 Hispanics (66%), and in 23 of 118 whites (19%) (P < 0.001 comparing Hispanics with whites and comparing Hispanics with African-Americans; P < 0.05 comparing African-Americans with whites). CONCLUSIONS: The prevalence of diabetes mellitus in 2003 older persons seen in an academic hospital-based geriatrics practice was 17% and was greater in Hispanics than in whites or African-Americans, and greater in African-Americans than in whites. The prevalence of target-organ damage/clinical cardiovascular disease was 85% in 335 older patients with diabetes. The prevalence of stroke or transient cerebral ischaemic attack was greater in older African-Americans with diabetes mellitus than in older whites with the disorder. The prevalence of diabetic nephropathy and of target-organ damage/clinical cardiovascular disease was greater in older African-Americans with diabetes mellitus than in older whites and Hispanics with diabetes mellitus. The prevalence of poor glycaemic control was greater in Hispanics than in whites or African-Americans and greater in African-Americans than in whites.     

Diabetes is a predictor of coronary artery stenosis in patients hospitalized with heart failure

In patients with heart failure, coronary artery disease is the most common underlying heart disease, and is associated with increased mortality. However, estimating the presence or absence of coronary artery disease in patients with heart failure is sometimes difficult without coronary imaging. We reviewed 155 consecutive patients hospitalized with heart failure who underwent coronary angiography. The patients were divided into two groups: patients with (N = 59) and without (N = 96) coronary artery stenosis. The clinical characteristics and blood sampling data were compared between the two groups. The patients with coronary artery stenosis were older than those without. The prevalence of diabetes mellitus (DM), dyslipidemia and a history of revascularization was higher in the patients with coronary artery stenosis. Patients with coronary artery stenosis tended to have wall motion asynergy more frequently than those without. On the other hand, the prevalence of atrial fibrillation (AF) was lower in patients with coronary artery stenosis. The serum hemoglobin level and estimated glomerular filtration rate were lower in patients with coronary artery stenosis than in those without. In the multivariate analysis, DM (odds ratio 3.517, 95 % CI 1.601–7.727) was found to be the only the predictor of the presence of coronary artery stenosis in patients with heart failure. In conclusion, coronary imaging is strongly recommended for heart failure patients with DM to confirm the presence of coronary artery stenosis.