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Increased risk of diabetes in CAD patients

The greater risk to patients with coronary artery disease (CAD) of also developing diabetes mellitus (DM) has been highlighted by the European Society of Cardiology (ESC), in an announcement to accompany World Diabetes Day (November 14th).

A number of studies indicating the scale of the problem are cited in the ESC statement. In the Swedish Registry for Coronary Care study1 it was found that 21% of patients experiencing acute myocardial infarction (AMI) were known to have diabetes. Furthermore the Euro Heart Survey on Diabetes and the Heart, which recruited patients from 25 countries, found that diabetes was identified in 25% of AMI patients who were not known to have diabetes when given an oral glucose tolerance test.2

Finally, a recent study3 showed that even coronary patients who were found to be clear of diabetes were at risk of going on to develop diabetes. The authors prospectively tracked 506 non-diabetic patients who had undergone coronary angiography for the evaluation of stable CAD.

Over 7.5 years of follow-up, the investigators found that 106 new cases of diabetes emerged (21.1%), which corresponds to a rate of 2.9% per year. The study also showed that for the 293 patients diagnosed with severe CAD, 26.4% went on to develop diabetes compared with 16.4% among those with less extensive disease.

When the research team scrutinised the various metabolic risk factors, they observed that besides fasting glucose, low high-density lipoprotein (HDL) cholesterol, elevated triglycerides, and a large waist circumference were strong predictors of the development of diabetes among coronary patients.

Professor Lena Jonasson, an ESC spokesperson from Linköping University, Sweden, comments, “This study underlines the need for good infrastructures to be put in place that allow all patients with CAD to be screened not only for diabetes at diagnosis, but to be followed on a regular basis”.

But there can be issues around whether patients with CAD are followed up by cardiologists in hospitals or family doctors, Prof Jonasson continued. “The reality is that cardiologists only follow patients carefully for a very short period and then refer them back to GPs. Whether they have further tests for diabetes depends on the individual interests of family doctors placing patients at risk of falling through the net,” she said.

Identifying patients who have both CAD and diabetes is essential because they need to be treated more aggressively with both drugs and life style interventions, says Professor Keith Fox (University of Edinburgh): “When patients have both diabetes and CAD the problem is that risk factors aren’t just simple additives, they multiply each other putting patients at greater risk of a worse outcome for both conditions”.

The spotlight of the ESC Congress 2013, to be held in Amsterdam, The Netherlands, from the 31st August – 4th September, will be how the heart interacts with other organs. “The heart should not be considered in isolation, and so we’ll be looking at how heart disease interacts not only with diabetes, but also with other organs systems such as the kidneys, brain, lungs, and the immune and haemopoietic systems,“ says Professor Fox.

References

1. Norhammar A, Malmberg K, Rydén L, Tornvall P, Stenestrand U, Wallentin L, For the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). Under utilisation of evidence-based treatment partially explains for the unfavourable prognosis in diabetic patients with acute myocardial infarction. Eur Heart J 2003;24:838–44. http://dx.doi.org/10.1016/S0195-668X(02)00828-X/

2. Bartnik M, Rydén L, Ferrari R, et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. Eur Heart J 2004;25:1880–90. http://dx.doi.org/10.1016/j.ehj.2004.07.027/

3. C Saely, A Vonbank, P Rein, et al. Coronary artery disease as a risk for developing type 2 diabetes mellitus. Abstract no. 339.Presented at 48th Annual Meeting of the European Association for the Study of Diabetes. 1-5 October 2012. Berlin, Germany.

Published on: November 15, 2012

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