1. Lack of correlation between the optimal glycaemic control and coronary micro vascular dysfunction in patients with diabetes mellitus: a cross sectional study
- Author
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Amir Lerman, Yasushi Matsuzawa, Lilach O. Lerman, Ryan J. Lennon, Taek Geun Kwon, Luis Felipe Valenzuela-Garcia, Jaskanwal D. Sara, Rafael J. Ruiz-Salmeron, [Valenzuela-Garcia,LF, Ruiz-Salmeron,RJ] Heart Center, Virgen Macarena Hospital, Seville, Spain. [Matsuzawa,Y, Sara,JDS, Kwon,TG] Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo College of Medicine, Rochester, USA. [Lennon,RJ] Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, MN, USA. [Lerman,LO] Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA., and Andalusian Department for Equality and Social Well Being. Spain. The National Institute of Health (NIH Grants HL-92954 and AG-31750), the Mayo Foundation.
- Subjects
Blood Glucose ,Male ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Catheterization [Medical Subject Headings] ,Cardiac Catheterization ,endocrine system diseases ,medicine.medical_treatment ,Endocrinology, Diabetes and Metabolism ,Adenosina ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Chest pain ,Coronary Angiography ,Coronary artery disease ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,0302 clinical medicine ,Diabetes mellitus ,Risk Factors ,hemoglobina A glicosilada ,Cateterismo ,Odds Ratio ,Endothelial dysfunction ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Prevalence [Medical Subject Headings] ,Cardiac catheterization ,Original Investigation ,Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 2-Ring::Purines::Purine Nucleosides::Adenosine [Medical Subject Headings] ,Middle Aged ,Acetilcolina ,Coronary Vessels ,Echocardiography, Doppler ,3. Good health ,Treatment Outcome ,Cardiology ,Phenomena and Processes::Circulatory and Respiratory Physiological Phenomena::Cardiovascular Physiological Phenomena::Cardiovascular Physiological Processes::Blood Circulation::Microcirculation [Medical Subject Headings] ,Diseases::Nutritional and Metabolic Diseases::Metabolic Diseases::Glucose Metabolism Disorders::Diabetes Mellitus::Diabetes Mellitus, Type 2 [Medical Subject Headings] ,Female ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Research Design::Control Groups [Medical Subject Headings] ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Dolor precordial ,Chemicals and Drugs::Organic Chemicals::Amines::Biogenic Amines::Acetylcholine [Medical Subject Headings] ,Adult ,medicine.medical_specialty ,030209 endocrinology & metabolism ,Diabetic angiopathy ,03 medical and health sciences ,Chemicals and Drugs::Carbohydrates::Glycosides::Hemoglobin A, Glycosylated [Medical Subject Headings] ,Internal medicine ,Coronary Circulation ,medicine ,Humans ,Hypoglycemic Agents ,Diseases::Pathological Conditions, Signs and Symptoms::Signs and Symptoms::Pain::Chest Pain [Medical Subject Headings] ,Angiology ,Retrospective Studies ,Glycated Hemoglobin ,Chi-Square Distribution ,business.industry ,Microcirculation ,nutritional and metabolic diseases ,Odds ratio ,medicine.disease ,Cross-Sectional Studies ,Logistic Models ,Check Tags::Female [Medical Subject Headings] ,Diabetes Mellitus, Type 2 ,Microvessels ,Coronary microcirculation ,business ,Biomarkers ,Diabetic Angiopathies ,Glucosa sanguínea ,Chemicals and Drugs::Carbohydrates::Monosaccharides::Hexoses::Glucose::Blood Glucose [Medical Subject Headings] - Abstract
Background Coronary microvascular dysfunction (CMD) is associated with cardiovascular events in type 2 diabetes mellitus (T2DM). Optimal glycaemic control does not always preclude future events. We sought to assess the effect of the current target of HBA1c level on the coronary microcirculatory function and identify predictive factors for CMD in T2DM patients. Methods We studied 100 patients with T2DM and 214 patients without T2DM. All of them with a history of chest pain, non-obstructive angiograms and a direct assessment of coronary blood flow increase in response to adenosine and acetylcholine coronary infusion, for evaluation of endothelial independent and dependent CMD. Patients with T2DM were categorized as having optimal (HbA1c < 7 %) vs. suboptimal (HbA1c ≥ 7 %) glycaemic control at the time of catheterization. Results Baseline characteristics and coronary endothelial function parameters differed significantly between T2DM patients and control group. The prevalence of endothelial independent CMD (29.8 vs. 39.6 %, p = 0.40) and dependent CMD (61.7 vs. 62.2 %, p = 1.00) were similar in patients with optimal vs. suboptimal glycaemic control. Age (OR 1.10; CI 95 % 1.04–1.18; p < 0.001) and female gender (OR 3.87; CI 95 % 1.45–11.4; p < 0.01) were significantly associated with endothelial independent CMD whereas glomerular filtrate (OR 0.97; CI 95 % 0.95–0.99; p < 0.05) was significantly associated with endothelial dependent CMD. The optimal glycaemic control was not associated with endothelial independent (OR 0.60, CI 95 % 0.23–1.46; p 0.26) or dependent CMD (OR 0.99, CI 95 % 0.43–2.24; p = 0.98). Conclusions The current target of HBA1c level does not predict a better coronary microcirculatory function in T2DM patients. The appropriate strategy for prevention of CMD in T2DM patients remains to be addressed. Keywords: Endothelial dysfunction; Diabetes mellitus; Coronary microcirculation Yes
- Published
- 2015