BackgroundMicrovascular function is impaired in patients with stable coronary artery disease. The aim was to study microvascular function in patients with diabetes and acute coronary syndrome (ACS).MethodsMicrovascular function was evaluated in 83 patients by laser Doppler fluxmetry (LDF) [PU; perfusion unit, median (interquartile range)] measuring resting LDF and peak LDF following a six min heating of the skin to 44 °C at the foot, respectively. All patients with ACS and without previously known diabetes underwent oral glucose tolerance test. Thirty-nine patients with type 2 diabetes mellitus free from coronary artery disease served as controls.ResultsPeak LDF was significantly (P = 0.03) lower in patients with ACS and diabetes (n = 22; 72 (52)) and diabetes without coronary artery disease (n = 39; 69 (51)) as compared to patients with ACS without diabetes (n = 46; 97 (60)), and patients without ACS (n = 15; 140 (121)), respectively. Patients with ACS (n = 68) had significantly (P = 0.04) lower peak LDF (92 (49)) as compared to patients without ACS (n = 15) (140 (121)).ConclusionMicrovascular reactivity is severely impaired in patients with diabetes and ACS. Diabetes has a major influence on microvascular function in patients with coronary artery disease.
Background: Endothelin-1 may be involved in the development of diabetic microangiopathy. We studied the effect of endothelin-1 blockade on myocardial microcirculation during coronary stenting. Patients and methods:Patients with type 2 diabetes and stable coronary artery disease undergoing elective percutaneous coronary intervention (PCI) were randomized to bolus dose of 500 mg bosentan (n = 4), a dual endothelin receptor blocker, or intracoronary administration of 0.03 mmol BQ123 (n = 6), a selective endothelin A-receptor blocker, or placebo (n = 5), respectively. Coronary flow reserve (CFR) was measured immediately post-PCI. CFR was also measured in five nondiabetic controls post-coronary stenting. Results: Patients in the placebo group had (P 0.05) lower values of CFR (2.3 ± 1.2) as compared to those who received endothelin blockade (n = 10; 3.1 ± 0.7) and nondiabetic controls (4.9 ± 2.3). Patients who received BQ123 showed significantly higher CFR (3.3 ± 0.5; P 0.05) as compared to those on placebo. Nondiabetic patients had significantly higher CFR as compared to patients with diabetes (4.9 ± 2.3 and 2.8 ± 1.0, respectively; P 0.05). Conclusion: Coronary microvascular dysfunction is present during coronary stenting in patients with type 2 diabetes and may be reversed by selective endothelin A-receptor blockade. Targeting endothelin system may be of importance in protecting the myocardium against ischemic events during elective PCI in type 2 diabetic patients.
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Objective We studied the effect of the GLP‐1RA exenatide on skin microvascular function in patients with T2DM and CAD. Methods Thirty‐five patients with T2DM, CAD, and HbA1C 42–86 mmol/mol were randomized to treatment with exenatide or conventional non‐GLP‐1‐based therapy for 12 weeks. Skin microvascular function was examined in the forearm by LDF and iontophoretic application of acetyl choline and SNP, and by PORH at baseline and after 12 weeks. Blood samples for fasting plasma glucose, HbA1C, and lipid profile were collected. Results At 12 weeks, patients on exenatide showed reductions in HbA1C (from 63.5 ± 13 to 60.7 ± 14 mmol/mol, p = .065), body weight (from 92.6 ± 16 to 89 ± 16 kg, p < .001), and systolic blood pressure (from 141 ± 13 to 134 ± 16 mm Hg, p < .05) as compared to the conventionally treated group. There were no significant changes in skin microvascular function between or within the two groups at follow‐up. Conclusions Three months' daily treatment with the GLP‐1RA exenatide in T2DM patients with CAD showed no significant effects on skin microvascular function or blood glucose control, while this study confirms a reduction in body weight and blood pressure by exenatide, as compared to conventional antidiabetic drug treatment.
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