Characteristics of Patients With Diabetes Having Normal Coronary Arteries

Abstract

We evaluated the association between risk variables in diabetic patients with normal and diseased coronary arteries in a retrospective cohort study conducted at Rashid Hospital, Dubai. A total of 4446 patients underwent coronary angiography due to various indications; 43% had type 2 diabetes mellitus (T2DM). Among the diabetic patients, 94% had diseased coronary arteries and the remaining 6% had absolutely normal arteries. The normal coronary group had significantly lower low-density lipoprotein cholesterol (LDL-C) and a higher high-density lipoprotein cholesterol (HDL-C) levels than the diseased group. Patients with normal coronaries were more likely to be females, have T2DM for a shorter duration, and were nonsmokers and non-South Asians. They also had lower levels of LDL, hemoglobin A1c, and fasting glucose and higher levels of HDL-C. Apart from these variables, genetic or environmental factors could protect these patients from atherosclerosis.

Association between coronary artery atherosclerosis and plasma glucose levels assessed by dual-source computed tomography

“…In a study of 98 asymptomatic individuals with T2DM without known CAD, Rassi et al (23) found a significant number (44%) had CAD based upon CTA. In contrast, Binbrek et al (24) found that only 5.5% of 1902 patients with T2DM in Dubai had normal coronary arteries. In the latter study, the group with normal coronary arteries had significantly lower LDL-C and higher HDL-C levels compared to the diseased group.…”

Postprandial Glucose Increases the Risk of Coronary Artery Disease

“…1 This difference may be due to higher postprandial glucose levels raising the HbA 1c . Unfortunately, postprandial glucose levels in the Binbrek et al study were not specified.…”

“…Unfortunately, postprandial glucose levels in the Binbrek et al study were not specified. 1 There is a study showing that the severity of coronary artery disease (CAD) is related to high postprandial glucose. 3 Several studies reported that postprandial glucose levels were more related to cardiovascular mortality than fasting plasma glucose.…”

“…We read the article entitled “Characteristics of patients with diabetes having normal coronary arteries” by Binbrek et al with interest. 1 At baseline, patients with abnormal coronary angiography (CAG) had a fasting glucose level of 145 mg/dL, with a hemoglobin A 1c (HbA 1c ) of 8.4%. The normal CAG group had corresponding levels of 131 mg/dL and 6.9%.…”

“…The normal CAG group had corresponding levels of 131 mg/dL and 6.9%. 1 However, Nathan et al showed that estimated average (fasting and postprandial) glucose levels in both type 1 and type 2 diabetic patients under treatment were approximately 154, 183, and 212 mg/dL with HbA 1c values of 7%, 8%, and 9%, respectively. 2 Based on these results, the HbA 1c value of the abnormal CAG group is much higher than expected.…”