Relationship Between High Glycated Hemoglobin and Severity of Coronary Artery Disease in Type II Diabetic Patients Hospitalized With Acute Coronary Syndrome

Abstract

Introduction Diabetes mellitus (DM) is a chronic metabolic disease. It is the principal cause behind the high morbidity and mortality attributed to cardiovascular disease. This article's objective was to determine a connection between high glycated haemoglobin levels (HbA1c) and coronary artery disease (CAD). Materials and Methods Cross-sectional research took place at the lady reading hospital, Peshawar, Pakistan, from 1st July 2020 to 31st December 2020. In this study, one hundred fifty-one type II diabetic patients took part. We labelled all of them as acute coronary syndrome (ACS) on arrival. Non-probability consecutive random sampling technique was used for sampling. We categorized patients based on their HbA1c levels into two groups. These groups included good glycemic control (HBA1c≤7. 5%) and patients with poor glycemic control (HBA1c ≥7.5%). We classified the angiographic results of these patients as normal coronary arteries (NCAs), single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD). Continuous variables such as age, weight, height, and body mass index (BMI) between HBA1c levels were analyzed using the Mann-Whitney U test. The fisher's exact test was performed to compare the categorical variables between the two classes. Results Of the total 151 patients, 89 (58.9%) were males, and the rest were female. The mean age was 55.4 ± 11.2 years. The most common risk factors were diabetes and hypertension, whereas ST-segment elevation myocardial infarction (STEMI) was the most common presentation. 107 (70.86%) patients had poor glycemic control (HbA1c>7.5%). Coronary angiographies showed TVD in 77 (50.99%) patients. Among these patients with TVD, 6 (14%) patients had good glycemic control, while 71 (66%) patients had poor glycemic control, which is significant (P≤0. 001). None of the patients with poor glycemic control had NCAs. Conclusion This article found a link between high levels of HbA1c and the degree of coronary artery disease (CAD) among diabetic patients. Our study's results demonstrated that high HbA1c was related to severe CAD. It would need additional studies with a large sample size to evaluate the more profound impact of HBA1c on coronary arteries.

Association of overweight and obesity with coronary risk factors and the presence of multivessel disease in patients with obstructive coronary artery disease – A nationwide registry study

“…However, the severity of coronary artery disease was associated with the presence of diabetes, like in our data. Supporting our findings, Khan et al [ 41 ] observed that a high level of HbA1c was associated with an increased severity of coronary artery disease. Our study observed an association between multivessel disease and the presence of diabetes, hypertension, and smoking status.…”

Protective effects of paraoxonase-1, vitamin E and selenium, and oxidative stress index on the susceptibility of low density lipoprotein to oxidation in diabetic patients with/without coronary artery disease

“…While in Xu's study, this increase in amount was not seen, and even in some groups with CAD, such as severe obstruction, the amount is lower than that of diabetics without CAD, which was the reason for insulin injection by this group [ 17 ], while in our study, people injecting insulin were excluded from the study. The results of Khan's study in 2021 were completely opposite to Xu's results and the amount of HbA1c in diabetic patients with CAD is more and high HbA1c was related to severe CAD [ 23 ].…”

Raised Glycated Hemoglobin (HbA1c) Level as a Risk Factor for Myocardial Infarction in Diabetic Patients: A Hospital-Based, Cross-Sectional Study in Peshawar

“…A study carried out in Peshawar Lady Reading Hospital in 2020 studied the degree of severity of CAD with HbA1c levels categorizing patients into two groups, namely, poor glycemic control (HbA1c >7.5%) and good glycemic control (HbA1c <7.5%) [14]. The study found a significant association between poor glycemic control and the severity of CAD.…”