Relationship Between HbA1c and Asymptomatic Coronary Artery Disease in Type 2 Diabetes Patients
M. Dundua, T. Akhobadze, R. Kurashvili & A. Kopaleishvili
Background: Patients with type 2 diabetes mellitus (T2DM) have elevated risk of coronary artery disease (CAD) development. In this population CAD often proceedsasymptomatically, especially if cardiac autonomic neuropathy (CAN) is present. Our aim was to assess relation between glycemia control and asymptomatic CAD inT2DM pts. Materials and methods: Participants were 160 T2DM patients without documented CAD divided into four groups (Gr.) according to HbA1c levels: Gr. 1 -HbA1c6.07.0%(n=42; mean age (MA)- 48.3+9.1yrs; 27m/15f); Gr. 2 - HbA1c 6.08.0% (n=46; MA 51.4+6.7yrs; 26m/20f); Gr. 3 -HbA1c8.010.0% (n=40; MA 49.9+7.1yrs; 22m/18f); Gr. 4 - HbA1c>10.0% (n=32;MA 51.9+9.7yrs; 17m/15f). In Gr. 1 target HbA1c (6.07.0%) were selected individually. In all pts 12 - lead rest ECG,exercisestress-tests (veloergometry) or 24-hr. Holter ECG were performed. To put final CAD diagnosis coronary angiography was performed in subjects with positive stress-test or ischemic episodes on Holter ECG. Results: Abnormal ECG atrest was observed in 7.1% of Gr. 1, 6.5% - Gr. 2, 12.5% - Gr. 3 and 15.6% of Gr. 4 patients. Positive stress test or ischemic episodes on Holter ECG were found in 38 out of 160 (23.8%) patients, and were more frequently observed, when HbA1c levels were high - 11.9% - Gr. 1; 19.6%-Gr. 2; 30%-Gr. 3 and 37.5%ofGr. 4 patients. Among 38 pts with positive stress-test or ischemic episodes on Holter ECG, 23 subjects received CAG, CAD was diagnosed in 14(60.9%) patients. Conclusion: Hyperglycemia, reflected by significantly elevated HbA1c levels, is associated with increased risk of CAD development that often proceeds asymptomatic. This may be due to CAN, caused by elevated glycemia levels. In uncontrolled T2DM more attention should be paid to glycemia normalization and early CAD revealing. This will permit to timely take necessary measures to improve the outcomes.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.