Factors associated with no apparent coronary artery disease in patients with type 2 diabetes mellitus for more than 10 years of duration: a case control study

Abstract

BackgroundType 2 diabetes mellitus is an important risk factor in the development of coronary artery disease (CAD) and is often associated with severe disease. However, this risk is not uniform, some patients remain free of CAD even after many years of treatment for diabetes. The present study was aimed to identify the factors that are associated with a favorable CAD profile.MethodsA case–control study of 76 patients with type 2 diabetes mellitus who were on treatment for more than 10 years duration and undergoing a coronary angiogram for the evaluation of clinically suspected CAD at a tertiary care hospital were recruited for the study. The presence and absence of significant CAD was determined after a coronary angiogram. Clinical history, and anthropometric and biochemical parameters were analyzed. Insulin resistance was determined by the Homeostasis Model Assessment. Multiple logistic regressions were done to find out the factors associated for a favorable CAD profile.ResultsThe difference in HOMA-IR (2.37 ± 0.69 VS 3.77 ± 1.64, p < 0.001) and urine microalbumin (24.15 ± 32.16 VS 82.72 ± 117.70, p = 0.004) were found to be statistically significant among those who did not have CAD when compared to those who had CAD. The difference in lipid profile, HbA1C, fasting blood sugar, BMI, waist hip ratio, waist and hip circumference was not significant. The adjusted odds ratio for insulin resistance less than 2.5 (OR 9.09, 95 % CI 1.91–41.83, p = 0.005), females (OR 7.91, 95 % CI 1.55–40.38, p = 0.013) and microalbumin <20 mg/l (OR 4.57, 95 % CI 1.17–17.85, p = 0.029) were independently associated with normal coronaries. The adjusted odds ratio for lipid profile, BMI, blood pressure and HbA1C were not significant.ConclusionsHOMA-IR less than 2.5, microalbuminuria less than 20 mg/l and females are the factors appear to be associated with no apparent CAD.

Screening and Risk Assessment of Coronary Artery Disease in Patients With Type 2 Diabetes: An Updated Review

“…Still in 2015, another study of 76 participants who were angiographically tested for the detection of CAD has estimated the role of insulin resistance and other markers of type 2 diabetes in the development of CAD (Table I) (21). This study has shown that low levels of insulin resistance and microalbuminuria, and female sex constitute negative factors for the development of CAD in patients suffering from diabetes type 2 for more than 10 years.…”

“…This study has shown that low levels of insulin resistance and microalbuminuria, and female sex constitute negative factors for the development of CAD in patients suffering from diabetes type 2 for more than 10 years. Srinivasan's study suggested that these factors improve prognosis concerning the CAD profile (21).…”

Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) in the Diagnosis of Insulin Resistance and Prediabetes

“…There is wide variations in the cutoff levels of HOMA-IR some studies have determined it to be 2-2.5 in Indian population. This inference was based upon the fact that HOMA-IR less than 2.5 appeared to be associated with no apparent coronary artery disease or other cardiovascular complications (18) . The cutoff value is different for different population like one large study study comprising of Hispanic population of 1854 adults concluded that cutoff value of HOMA-IR was 3.80.…”

Metabolic Syndrome Versus Its Individual Components and Angiographic Severity of Coronary Artery Disease.

“…[25] In agreement with our work, other study concluded that diabetes and high FBG not the metabolic syndrome itself predicted the severity and extent of CAD. [26] Other studies high lightened the value of blood pressure and stated that elevated blood pressure for CAD events and high FBG for CAD remained as independent predictors in all definitions. [27] Conclusion:-FBG, high TGs and high blood pressure were independent predictors CAD rather than metabolic syndrome itself.…”