Lack of correlation between the optimal glycaemic control and coronary micro vascular dysfunction in patients with diabetes mellitus: a cross sectional study

Abstract

BackgroundCoronary microvascular dysfunction (CMD) is associated with cardiovascular events in type 2 diabetes mellitus (T2DM). Optimal glycaemic control does not always preclude future events. We sought to assess the effect of the current target of HBA1c level on the coronary microcirculatory function and identify predictive factors for CMD in T2DM patients.MethodsWe studied 100 patients with T2DM and 214 patients without T2DM. All of them with a history of chest pain, non-obstructive angiograms and a direct assessment of coronary blood flow increase in response to adenosine and acetylcholine coronary infusion, for evaluation of endothelial independent and dependent CMD. Patients with T2DM were categorized as having optimal (HbA1c < 7 %) vs. suboptimal (HbA1c ≥ 7 %) glycaemic control at the time of catheterization.ResultsBaseline characteristics and coronary endothelial function parameters differed significantly between T2DM patients and control group. The prevalence of endothelial independent CMD (29.8 vs. 39.6 %, p = 0.40) and dependent CMD (61.7 vs. 62.2 %, p = 1.00) were similar in patients with optimal vs. suboptimal glycaemic control. Age (OR 1.10; CI 95 % 1.04–1.18; p < 0.001) and female gender (OR 3.87; CI 95 % 1.45–11.4; p < 0.01) were significantly associated with endothelial independent CMD whereas glomerular filtrate (OR 0.97; CI 95 % 0.95–0.99; p < 0.05) was significantly associated with endothelial dependent CMD. The optimal glycaemic control was not associated with endothelial independent (OR 0.60, CI 95 % 0.23–1.46; p 0.26) or dependent CMD (OR 0.99, CI 95 % 0.43–2.24; p = 0.98).ConclusionsThe current target of HBA1c level does not predict a better coronary microcirculatory function in T2DM patients. The appropriate strategy for prevention of CMD in T2DM patients remains to be addressed.

Arginase inhibition improves endothelial function in patients with type 2 diabetes mellitus despite intensive glucose‐lowering therapy

“…In line with previous data, we observed a difference in baseline EDV between healthy subjects and patients with T2DM . As expected, we did not observe a difference in EDV before compared to after intensive glucose‐lowering therapy in the T2DM group, in line with other studies on the subject.…”

“…This is further supported by Valenzuela‐Garcia et al . who failed to show a difference in endothelium‐dependent coronary microvascular function between T2DM patients with optimal vs. suboptimal glycaemic control. Interestingly, acute administration of glucose induces ED in healthy subjects, which is attributable to an acute deficit in NO and increase in ROS .…”

The impact of cardiovascular co-morbidities and duration of diabetes on the association between microvascular function and glycaemic control

“…Although microvascular dysfunction in those with CVD is explained by cardiovascular risk factors [ 25 ], the mechanism through which sustained hyperglycaemia causes vascular complications is less clear. Contemporaneous optimal glycaemic control is not associated with improved coronary microvascular response, suggesting that the adverse function may be as a result of glycaemic legacy effect [ 28 ]. It is generally understood that hyperglycaemia acts on endothelial cell function [ 29 ] and resultant microvascular endothelial dysfunction perpetuates a cycle with a reduction in insulin-mediated glucose uptake.…”

The prevalence of diabetes, hypertension and obesity among immigrants from East Africa and the former Soviet Union: a retrospective comparative 30-year cohort study

“…It is of note that the prevalence of ischemic heart disease, cerebrovascular disease and peripheral vascular disease in EAI was lower than in the other two groups despite the higher prevalence of diabetes. A possible explanation suggested by Valenzuela-Garcia et al [ 35 ] is that even the degree of glycaemic control in diabetes is not always correlated with coronary flow. Similar findings were reported for microvascular complications [ 36 ].…”