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Dyslipidemia Pattern And Ischemic Heart Disease In Type 2 Diabetes Patients

Research suggests screening for latent coronary artery disease to decrease complications.

Ischemic heart disease is a leading cause of death worldwide and its presence in diabetes mellitus patients is a dreaded combination. T2D leads to an increase in morbidity, mortality, and a low quality of life for the patient. The disease, with its complications, is a major cause of a heavy economic burden to the patients.

This research study was aimed at dyslipidemia patterns and different types of ischemic heart diseases in T2D patients in India. The industrialization boom in India has led to a sedentary lifestyle among its population accompanied by psychosocial stress and obesity contributing to an increase in prevalence of diabetes cases. With diabetes comes an increase in the prevalence of both micro- and macrovascular complications such as neuropathy, nephropathy, CVD, retinopathy, peripheral vascular disease, and many, more complications. Only a few of these risk factors of type 2 diabetes contribute to ischemic heart disease. Traditional coronary artery disease risk factors such as high blood pressure, high choresterolemia, and an increase in insulin resistance are mostly found in diabetes patients. Studies have shown that more than half of diabetes patients have high blood pressure and more than a third of these patients have high cholesterol at the time of their diagnosis. Diabetes patients have a five-fold risk of getting Ischemic heart disease compared to patients without diabetes and therefore early diagnosis of IHD in DM patients is important for management and prognostic purposes.

In this study, 100 type 2 diabetes patients age30 and over with or without ischemic heart disease symptoms were recruited over 18 months. Among these patients, 41 had IHD out of which 16 had angina pectoris. Those with type 1 diabetes, gestational diabetes, pulmonary embolism, pericarditis, and endocarditis were excluded from the study. All patients were subjected to a baseline electrocardiogram and those who showed normal were further evaluated using a Treadmill Stress test for subclinical cardiac involvement. The mean age of diabetes was 8.66 years and mean fasting and postprandial blood sugars were 190.36mg/dL and 262.78mg/dL respectively

For Statistical analysis, continuous data was shown using mean+/- SD while categorical data was presented as percentage values. An alpha value of 0.05 or less was assumed to be significant. Student t-test and chi square test were used to analyze significance of metric parameters and categorical parameters respectively.

In this study, retinopathy, nephropathy, and neuropathy were the most predominant microvascular complications at 46%, 11% and 14% respectively. Those who had high blood pressure were 43% while a majority of 68.3% had IHD, which was statistically significant. Forty seven percent of the smokers had ischemic heart disease although this was found not to be statistically significant. Incidence of IHD among those who consumed alcohol was 41.2% while that of participants with BMI > 25 was 23.8%. This was also not clinically significant. Among the obesity indices, only the percent body fat correlate significantly with CAD in patients with diabetes. Patients with coronary artery disease had higher mean total cholesterol, LDL cholesterol and triglycerides while HDL cholesterol was found to be lower in patients with CAD when compared with patients without CAD, and this was statistically significant. Retinopathy, neuropathy, nephropathy, high blood pressure, smoking, alcohol abuse, high BMI and dyslipidemia were all risk factors for CAD in patients with T2D.

There is a higher incidence of ischemic heart disease in people with diabetes when compared to the general population. Dyslipidemia is one of the most important metabolic abnormalities and a significant predictor of CAD in patients with diabetes mellitus.

Practice Pearls:

  • Traditional coronary artery disease risk factors such as high blood pressure, high choresterolemia, and increase in insulin resistance are mostly found in diabetes patients.
  • Early detection and treatment of hypertension can reduce the risk of cardiac complications.
  • Hypercholesterolemia, high LDL cholesterol, hypertriglyceridemia, and low HDL cholesterol are all significant predictors of coronary artery disease in diabetes mellitus.

References:

Rajkondawar AV.  Nandeshwar PB. Clinical profile of pattern of dyslipidemia and Ischemic Heart Disease in T2D patients. J. Evid. Based Med. 2349-2570/ Vol. 4/Issue 60/July 27, 2017

 

Josephat Macharia, PharmD candidate, Lecom School of Pharmacy class of 2018