Background: Diabetes mellitus (DM) is independently associated with an increased risk of cardiovascular mortality and morbidity, including coronary artery disease (CAD). CAD is a shared burden disease and the leading cause of death in developed and developing countries. We aimed to assess the angiographic patterns of coronary arteries in patients with DM in a developing country (Yemen) as the first study. Methods: This study is a cross-sectional, prospective, observational study that includes a total of 250 patients who were admitted for elective diagnostic coronary angiography. Results: 96 (38.4%) patients were diabetics; 68% were male; mean age was 57 ± 11 years. The incidence of three-vessel disease was 31.2% of patients. Considering the severity of lumen occlusion, (11.2%) of patients had non-significant lesions, (37.6%) of patients had significant lesions, and (32%) had total occlusive lesions. Lesions were of LAD in 76%, RCA in 60%, and LCX in 52% of the population. Among diabetics, two and 3-vessel diseases (33.3% vs. 20.8% & 50% vs. 19.5%, P = 0.001), left main lesion (10.4% vs. 2.6%, P = 0.012), significant stenosis (41.7% vs. 35.1%, P = 0.032), total occlusion of coronary arteries (43.8% vs. 19.5%, P = 0.032) and type C lesion (66.7% vs. 35.1%, P = 0.010) were more frequent than non-DM patients. Conclusion: The burden of significant and severe coronary lesions is more common among DM, which may be the major cause of morbidity and mortality of DM in developing countries.
References
[1]
Khan, M.A., Hashim, M.J., Mustafa, H., et al. (2020) Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study. Cureus, 12, e9349. https://doi.org/10.7759/cureus.9349
[2]
Figtree, G.A., Adamson, P.D., Antoniades, C., et al. (2022) Noninvasive Plaque Imaging to Accelerate Coronary Artery Disease Drug Development. Circulation, 146, 1712-1727. https://doi.org/10.1161/CIRCULATIONAHA.122.060308
[3]
Kinoshita, M., Yokote, K., Arai, H., et al. (2018) Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017. Journal of Atherosclerosis and Thrombosis, 25, 846-984. https://doi.org/10.5551/jat.GL2017
[4]
Wong, N.D. and Sattar, N. (2023) Cardiovascular Risk in Diabetes Mellitus: Epidemiology, Assessment and Prevention. Nature Reviews Cardiology, 20, 685-695. https://doi.org/10.1038/s41569-023-00877-z
[5]
Calicchio, F., Manubolu, V.S., Dahal, S., et al. (2022) Obstructive Coronary Artery Disease in Symptomatic Diabetics with Zero Coronary Calcium Score: Are We Missing Something? Coronary Artery Disease, 33, 626-633. https://doi.org/10.1097/MCA.0000000000001184
[6]
Clodi, M., Saely, C.H., Hoppichler, F., et al. (2023) [Diabetes Mellitus, Coronary Artery Disease and Heart Disease (Update 2023)]. Wiener klinische Wochenschrift, 135, 201-206. https://doi.org/10.1007/s00508-023-02183-7
[7]
Roth, G.A., Johnson, C., Abajobir, A., et al. (2017) Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. Journal of the American College of Cardiology, 70, 1-25. https://doi.org/10.1016/j.jacc.2017.04.052
[8]
Elsayed, N.A., Aleppo, G., Aroda, V.R., et al. (2023) 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care, 46, S19-S40. https://doi.org/10.2337/dc23-S002
[9]
Dong, X., Li, N., Zhu, C., et al. (2023) Diagnosis of Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus Based on Computed Tomography and Pericoronary Adipose Tissue Radiomics: A Retrospective Cross-Sectional Study. Cardiovascular Diabetology, 22, Article No. 14. https://doi.org/10.1186/s12933-023-01748-0
[10]
Arnett, D.K., Blumenthal, R.S., Albert, M.A., et al. (2019) 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 74, 1376-1414. https://doi.org/10.1016/j.jacc.2019.03.009
[11]
American Diabetes Association Professional Practice Committee (2022) 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care, 45, S17-S38. https://doi.org/10.2337/dc22-S002
[12]
Knuuti, J., Wijns, W., Saraste, A., et al. (2020) 2019 ESC Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes. European Heart Journal, 41, 407-477. https://doi.org/10.1093/eurheartj/ehz425
[13]
Collet, J.P., Thiele, H., Barbato, E., et al. (2021) 2020 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation. European Heart Journal, 42, 1289-1367. https://doi.org/10.1093/eurheartj/ehaa575
[14]
Zipes, D.L.P., Bonow, R., Mann, D. and Tomaselli, G. (2018) Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Elsevier, Amsterdam.
[15]
Scanlon, P.J., Faxon, D.P., Audet, A.M., et al. (1999) ACC/AHA Guidelines for Coronary Angiography. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography). Developed in Collaboration with the Society for Cardiac Angiography and Interventions. Journal of the American College of Cardiology, 33, 1756-1824.
[16]
Patel, M.R., Peterson, E.D., Dai, D., et al. (2010) Low Diagnostic Yield of Elective Coronary Angiography. The New England Journal of Medicine, 362, 886-895. https://doi.org/10.1056/NEJMoa0907272
[17]
Sakakura, K., Ako, J., Wada, H., et al. (2012) ACC/AHA Classification of Coronary Lesions Reflects Medical Resource Use in Current Percutaneous Coronary Interventions. Catheterization and Cardiovascular Interventions, 80, 370-376. https://doi.org/10.1002/ccd.23270
[18]
Nigro, J., Osman, N., Dart, A.M., et al. (2006) Insulin Resistance and Atherosclerosis. Endocrine Reviews, 27, 242-259. https://doi.org/10.1210/er.2005-0007
[19]
Bornfeldt, K.E. and Tabas, I. (2011) Insulin Resistance, Hyperglycemia, and Atherosclerosis. Cell Metabolism, 14, 575-585. https://doi.org/10.1016/j.cmet.2011.07.015
[20]
Papatheodorou, K., Banach, M., Bekiari, E., et al. (2018) Complications of Diabetes 2017. Journal of Diabetes Research, 2018, Article ID: 3086167. https://doi.org/10.1155/2018/3086167
[21]
Sousa, J.M., Herrman, J.L., Teodoro, M., et al. (2006) [Comparison of Coronary Angiography Findings in Diabetic and Non-Diabetic Women with Non-ST-Seg-ment-Elevation Acute Coronary Syndrome]. Arquivos Brasileiros de Cardiologia, 86, 150-155. https://doi.org/10.1590/S0066-782X2006000200012
[22]
Ammann, P., Brunner-La Rocca, H., Fehr, T., et al. (2004) Coronary Anatomy and Left Ventricular Ejection Fraction in Patients with Type 2 Diabetes Admitted for Elective Coronary Angiography. Catheterization and Cardiovascular Interventions, 62, 432-438. https://doi.org/10.1002/ccd.20135
[23]
Graham, M.M., Ghali, W.A., Faris, P.D., et al. (2003) Sex Differences in the Prognostic Importance of Diabetes in Patients with Ischemic Heart Disease Undergoing Coronary Angiography. Diabetes Care, 26, 3142-3147. https://doi.org/10.2337/diacare.26.11.3142
[24]
Hegde, S.S., Mallesh, P., Yeli, S.M., et al. (2014) Comparative Angiographic Profile in Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome. Journal of Clinical and Diagnostic Research, 8, Mc07-10.
[25]
Hasabi, I.S. and Mudagall, G.S. (2020) A Comparative Study of Angiographic Severity of Coronary Artery Disease in Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome by Gensini Scoring System. Journal of Evidence-Based Medicine and Healthcare, 7, 1009-1013.
[26]
Iqbal, A.T., Salehuddin, M., Ayub, M., et al. (2019) A Comparative Study of Coronary Angiographic Data Between Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome. University Heart Journal, 15, 34-36. https://doi.org/10.3329/uhj.v15i1.41444
[27]
Marghany, K.A., El Baz, M.S., El Seddik-Tammam, A., et al. (2013) Comparison of Coronary Angiographic Findings in Diabetic and Non Diabetic Women in upper Egypt with Non ST Segment Elevation Myocardial Infarction. Journal of American Science, 9, 461-468.
[28]
Sharma, V., Sharma, K., Mansuri, Z., et al. (2020) Does Angiographic Profile and Outcome of Diabetic Patients among Asian Indians Correlate with Presenting Glycated Hemoglobin During Acute ST-Elevation Myocardial Infarction? DECIPHER Study. Journal of Primary Care Specialties, 6, 148-152. https://doi.org/10.4103/jpcs.jpcs_9_20
[29]
Mousavi, M., Nematipour, E. and Mehrpouya, M. (2006) Comparison of Extent of Coronary Artery Disease in Angiography of Diabetics and Non-Diabetics. Iranian Heart Journal, 7, 37-42.
[30]
Bharath, S. and Gosavi, S. (2020) Angiography Findings in Diabetic and Non-Diabetic Patients with Cardiac Symptoms. Journal of cardiovascular Disease Researches, 11, 60-63.
[31]
Sharma, R., Bhairappa, S., Prasad, S., et al. (2014) Clinical Characteristics, Angiographic Profile and in Hospital Mortality in Acute Coronary Syndrome Patients in South Indian Population. Heart India, 2, 65-69. https://doi.org/10.4103/2321-449X.140228
[32]
Narayanaswamy, G., Kshetrimayum, S., Sharma, H.D., et al. (2019) Profile of Patients Undergoing Coronary Angiography at Tertiary Care Center in Northeast India. Journal of Medical Society, 33, 28-32. https://doi.org/10.4103/jms.jms_101_17
[33]
Girdhar, R., Kothari, Y., Kamat, A.S., et al. (2018) Coronary Angiographic (CAG) Findings between Diabetic and Non Diabetic Patients in Coronary Artery Disease: A Comparative Study. Journal of Medical Science and clinical Research, 6, 753-759. https://doi.org/10.18535/jmscr/v6i8.126
[34]
Zand Parsa, A.F., Ziai, H. and Haghighi, L. (2012) The Impact of Cardiovascular Risk Factors on the Site and Extent of Coronary Artery Disease. Cardiovascular Journal of Africa, 23, 197-199. https://doi.org/10.5830/CVJA-2011-052
[35]
Mohammad, A.M., Jehangeer, H.I. and Shaikhow, S.K. (2015) Prevalence and Risk Factors of Premature Coronary Artery Disease in Patients Undergoing Coronary Angiography in Kurdistan, Iraq. BMC Cardiovascular Disorders, 15, Article No. 155. https://doi.org/10.1186/s12872-015-0145-7
[36]
Zhiming, Y., Yang, H.Y., Gong, S.W., et al. (2014) GW25-E4122 the Coronary Angiographic Characteristics of Diabetic Patients with High TG and Low HDL-C. Journal of the American College of Cardiology, 64, C147-C148. https://doi.org/10.1016/j.jacc.2014.06.678
