Coronary atherosclerosis in Type II diabetes: angiographic findings and clinical outcome

Natali, Andrea; Vichi, Silvia; Landi, Patrizia; Severi, Silva; LʼAbbate, Antonio; Ferrannini, Eleuterio

doi:10.1007/s001250051352

Cited by 167 publications

(108 citation statements)

References 36 publications

(32 reference statements)

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“…The higher rates of diffuse disease found in these studies is in line with the higher frequency of three-vessel disease and the presence of peripheral coronary artery disease in our study population. In contrast to the study of Natali et al [22], we were not able to detect a sex-specific pattern in coronary atherosclerosis in diabetic patients. The most likely explanation for this difference is the much higher number of diabetic patients investigated in the present study.…”

Section: Discussioncontrasting

confidence: 99%

“…Our study is the first that used established scores of the atherosclerotic burden determined by angiography in a large study population. The present findings of more severe coronary artery disease with higher atherosclerotic scores on angiography in patients with diabetes are confirmed in two recently published investigations by Ledru et al [14] and Natali et al [22], as well as two epidemiological studies [23,24] that also found a more severe and diffuse coronary atherosclerosis in diabetic patients. The higher rates of diffuse disease found in these studies is in line with the higher frequency of three-vessel disease and the presence of peripheral coronary artery disease in our study population.…”

Section: Discussionsupporting

confidence: 90%

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Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Ammann¹,

Rocca²,

Fehr³

et al. 2004

Cathet Cardio Intervent

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Patients with diabetes mellitus (DM) have more severe coronary artery disease and a two-to fourfold higher risk for myocardial infarction and death as compared to patients without DM. In this study, we analyzed coronary anatomy, left ventricular ejection fraction, and cardiac risk factors in patients with DM referred for coronary angiography and compared them with findings in nondiabetic patients. Coronary anatomy was assessed in a total of 6,234 patients and left ventricular ejection fraction in a subset of 4,767 (76.5%) patients. Diabetic patients (n ‫؍‬ 641) were older (60.8 ؎ 9.6 vs. 58.5 ؎ 10.5 years; P < 0.0001) and had higher rates of hypertension (65% vs. 47%; P < 0.0001). Three-vessel disease (DM 44.7% vs. no DM 25.4%; P < 0.0001) and reduced left ventricular ejection fraction (DM 58.4% ؎ 15.2 vs. no DM 63.9% ؎ 13.2; P < 0.0001) were significantly associated with DM. After adjustment for age and other vascular risk factors, the presence of DM was associated with a higher atherosclerotic burden. We conclude that advanced coronary heart disease and left ventricular dysfunction are highly prevalent in diabetic patients, independent of age and other cardiovascular risk factors. Thus, cardiac assessment in diabetic patients should, in addition to optimal diabetic control, involve screening for left ventricular dysfunction. Catheter Cardiovasc Interv 2004;62: 432-438.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 90%

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Ammann¹,

Rocca²,

Fehr³

et al. 2004

Cathet Cardio Intervent

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show abstract

“…In our cohort, patients with DM and coronary artery disease were older, more frequently female, and had a lower prevalence of current smoking. These findings are consistent with previous clinical studies 3, 4. The adjustment for these differences in baseline patient characteristics should have corrected the confounder effects on our results.…”

Section: Discussionsupporting

confidence: 92%

“…Coronary arteries of patients with DM are angiographically characterized as showing diffuse narrowing and multivessel disease 3, 4. Pathology studies have demonstrated that patients with DM have plaques with larger necrotic cores, increased presence of inflammation, and advanced coronary artery calcification 5.…”

Section: Introductionmentioning

confidence: 99%

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Sugiyama

Yamamoto

Bryniarski

et al. 2018

JAHA

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BackgroundDiabetes mellitus (DM) is a major risk factor for cardiovascular events. We aimed to investigate the coronary plaque phenotype of diabetic patients who presented with acute coronary syndromes by optical coherence tomography.Methods and ResultsA total of 322 patients with acute coronary syndromes who underwent preintervention optical coherence tomography imaging of the culprit lesion were included. Culprit plaque characteristics were compared between patients with DM (n=95) and those without DM (n=227). In the subgroup of 250 patients in whom sufficient length of nonculprit region in the culprit vessel was imaged by optical coherence tomography, the characteristics of nonculprit plaques were also evaluated. Patients with DM had a higher prevalence of lipid‐rich plaque (58.9% versus 44.9%, P=0.030) and macrophage accumulation (60.0% versus 44.9%, P=0.019) in the culprit lesion compared with patients without DM. The prevalence of plaque rupture (33.7% versus 30.4%, P=0.896) and plaque erosion (21.1% versus 22.0%, P=0.458) was similar. In the nonculprit lesions, the DM group had greater maximal lipid arc (248.9°±83.9° versus 179.9°±58.3°, P=0.006), thinner fibrous cap thickness (103.3±56.2 μm versus 140.7±70.0 μm, P=0.013), and a higher prevalence of thin‐cap fibroatheroma (17.2% versus 6.3%, P=0.031), compared with the non‐DM group.ConclusionsCompared with patients without DM, those with DM had more vulnerable features in both culprit and nonculprit lesions, thus indicating a higher level of panvascular instability.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01110538.

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“…This excess atherosclerosis is only partially explained by traditional risk factors [2]. Therefore, a role for hyperglycaemia itself emerges forcefully.…”

Section: Introductionmentioning

confidence: 99%

Effects of glucose tolerance on the changes provoked by glucose ingestion in microvascular function

et al. 2008

Self Cite

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Aims/hypothesis Hyperglycaemia and hyperinsulinaemia have opposite effects on endothelium-dependent vasodilatation in microcirculation, but the net effect elicited by glucose ingestion and the separate influence of glucose tolerance are unknown. Methods In participants with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) or diabetic glucose tolerance, multiple plasma markers of both oxidative stress and endothelial activation, and forearm vascular responses (plethysmography) to intra-arterial acetylcholine (ACh) and sodium nitroprusside (SNP) infusions were measured before and after glucose ingestion. In another IGT group, we evaluated the time-course of the skin vascular responses (laser Doppler) to ACh and SNP (by iontophoresis) 1, 2 and 3 h into the OGTT; the plasma glucose profile was then reproduced by means of a variable intravenous glucose infusion and the vascular measurements repeated. Results Following oral glucose, plasma antioxidants were reduced by 5% to 10% (p<0.01) in all patient groups. The response to acetylcholine was not affected by glucose ingestion in any group, while the response to SNP was attenuated, particularly in the IGT group. The ACh:SNP ratio was slightly improved therefore in all groups, even in diabetic participants, in whom it was impaired basally. A time-dependent improvement in ACh:SNP ratio was also observed in skin microcirculation following oral glucose; this improvement was blunted when matched hyperglycaemia was coupled with lower hyperinsulinaemia (intravenous glucose). Conclusions/interpretation Regardless of glucose tolerance, oral glucose does not impair endothelium-dependent vasodilatation either in resistance arteries or in the microcirculation, despite causing increased oxidative stress; the endogenous insulin response is probably responsible for countering any inhibitory effect on vascular function.

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Coronary atherosclerosis in Type II diabetes: angiographic findings and clinical outcome

Cited by 167 publications

References 36 publications

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Effects of glucose tolerance on the changes provoked by glucose ingestion in microvascular function

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