Screening for coronary artery disease in patients with type 2 diabetes mellitus: An evidence-based review

Chopra, Sandeep; Peter, Soumia

doi:10.4103/2230-8210.91202

Cited by 20 publications

(16 citation statements)

References 62 publications

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“…Several imaging modalities have been used to detect CAD in diabetic patients including invasive coronary angiography, myocardial scintigraphy and dobutamine stress echocardiography ( 3 ). Even if invasive coronary angiography is the gold standard for identifying obstructive lesions, it only depicts the lumen of the vessel, greatly underestimating the burden of atherosclerosis ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

In Vivo and In Vitro Analysis in Coronary Artery Disease Related to Type 2 Diabetes

et al. 2017

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AimThe leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (DM) is coronary artery disease (CAD), a condition often asymptomatic but severe in these patients. Although glucose metabolism impairment and oxidative stress are known actors in the endothelial dysfunction/remodeling that occurs in diabetic patients, the relationship between cardiovascular disorders and DM is not fully understood. We have performed both an in vivo imaging and in vitro molecular analysis to investigate diabetic-specific CAD alterations.MethodsComputed tomography coronary angiography (CTCA) was performed in a group of 20 diabetic patients with CAD (DM+CAD+), 20 non-diabetic with CAD (DM−CAD+), 10 diabetic non-CAD patients (DM+CAD−), and 20 non-diabetic healthy subjects (HS). Imaging quantitative parameters such as calcium score (Cascore), calcified plaque volume (CPV), non-calcified plaque volume (NCPV), total plaque volume (TPV), remodeling index (RI), and plaque burden were extracted for each CAD subject. Moreover, the expression levels of superoxide dismutase 2 (SOD2) and liver X receptor alpha (LXRα) genes were analyzed in the peripheral blood mononuclear cells, whereas hyaluronan (HA) concentrations were evaluated in the plasma of each subject.ResultsImaging parameters, such as Cascore, CPV, RI, and plaque burden, were significantly higher in DM+CAD+ group, compared to DM−CAD+ (P = 0.019; P = 0.014; P < 0.001, P < 0.001, respectively). SOD2 mRNA was downregulated, while LXRα gene expression was upregulated in DM+CAD−, DM+CAD+, and DM−CAD+ groups compared to HS (P = 0.001, P = 0.03, and P = 0.001 for SOD2 and P = 0.006, P = 0.008, and P < 0.001 for LXRα, respectively). Plasmatic levels of HA were higher in DM−CAD+, DM+CAD−, and DM+CAD+ groups, compared to HS (P = 0.001 for the three groups). When compared to DM−CAD+, HA concentration was higher in DM+CAD− (P = 0.008) and DM+CAD+ (P < 0.001) with a significant difference between the two diabetic groups (P = 0.003). Moreover, HA showed a significant association with diabetes (P = 0.01) in the study population, and the correlation between HA levels and glycemia was statistically significant (ρ = 0.73, P < 0.001).ConclusionIn our population, imaging parameters highlight a greater severity of CAD in diabetic patients. Among molecular parameters, HA is modulated by diabetic CAD-related alterations while SOD2 and LXRα are found to be more associated with CAD but do not discriminate between diabetic and non-diabetic subgroups.

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Section: Introductionmentioning

confidence: 99%

In Vivo and In Vitro Analysis in Coronary Artery Disease Related to Type 2 Diabetes

et al. 2017

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“…As a result, multi vessel atherosclerosis often is present before ischemic symptoms occur and before treatment can be instituted. 8 Viswanathan Mohan et al, reported 21.5% prevalence of CAD and it was reported to be 10% and 15% by another study. [9][10][11] In the present study the prevalence was 39%.…”

Section: Discussionmentioning

confidence: 90%

Prevalence of coronary artery diseases in type 2 diabetic women

et al. 2019

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Background: There was increasing evidence that gender differences are important in epidemiology, treatment and outcomes of many diseases, relevant for non-communicable diseases.Methods: Study was conducted in Department of General Medicine, GSL Medical College. Patients who were admitted with type 2 diabetes were recruited in the study. Each patient was interviewed to obtain detailed history and examined thoroughly as per predetermined protocol, national diabetes data group and WHO diagnostic criteria was used. Myocardial infarction was diagnosed by convex ST segment elevation in corresponding leads (early) or QS complexes or abnormal Q waves i.e. Q waves of 0.04 seconds or more in width (or) 25% or more of the voltage of the R wave in the same lead or both in the corresponding leads (late) or T wave inversion in the corresponding leads (late). Statistical analyses were done by using SPSS software version 21.0. Chi-square test was used to assess the association between different categorical variables; p<0.05 was considered statistically significant.Results: Out of 250 participants, 97 were diagnosed as coronary artery disease (CAD), maximum between 51-60 years age group; the difference was statistically significant (p<0.05). The association between dyslipidemia and CAD was statistically significant (p<0.05). Out of 188 post-menopausal cases, CAD was diagnosed in 86 cases; out of the 62 non post-menopausal cases, CAD was diagnosed in 11 cases; The difference was statistically significant (p<0.05).Conclusions: In premenopausal women, the prevalence of CHDs are significantly higher when compared to postmenopausal women.

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“…The very limited number of clinical trials conducted to date means that no comprehensive strategy for CAD screening in diabetic patients can be proposed. 10,11 Although exercise treadmill test is recommended in asymptomatic diabetic patients or in individuals who are about to embark on moderate to high-intensity exercise, 18,19 its use is limited to patients who can exercise and have a normal baseline electrocardiogram.…”

Section: Discussionmentioning

confidence: 99%

Holter monitoring for the screening of cardiac disease in diabetes mellitus: The non-invasive Holter monitoring observation of new cardiac events in diabetics study

Nakao

Ueshima

Nohara

et al. 2015

Diabetes and Vascular Disease Research

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We investigated the usefulness of Holter monitoring to detect cardiac disease and predict future cardiovascular risk in asymptomatic diabetic patients. This is a multi-centre, prospective study in 406 asymptomatic diabetic patients. They were categorized into three groups based on findings of Holter monitoring. A total of 377 met inclusion criteria and were classified as low (n = 172), moderate (n = 136) and high risk (n = 69). In total, 86 in moderate and 53 in high risk receive further evaluation. In total, 29 in moderate and 25 in high risk were diagnosed as cardiac disease and 12 required additional treatment, including coronary intervention. Over 1.8 years of mean follow-up, 11 (16.5 per 1000 person-years) experienced cardiovascular events. The cumulative incidence in moderate and high risk was higher than that in low risk (p = 0.029 and p = 0.014, respectively). Our study suggests that Holter monitoring may be a useful screening tool to detect cardiac disease and predict future cardiovascular risk in asymptomatic diabetic patients.

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Screening for coronary artery disease in patients with type 2 diabetes mellitus: An evidence-based review

Cited by 20 publications

References 62 publications

In Vivo and In Vitro Analysis in Coronary Artery Disease Related to Type 2 Diabetes

In Vivo and In Vitro Analysis in Coronary Artery Disease Related to Type 2 Diabetes

Prevalence of coronary artery diseases in type 2 diabetic women

Holter monitoring for the screening of cardiac disease in diabetes mellitus: The non-invasive Holter monitoring observation of new cardiac events in diabetics study

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