Clinical And Angiographic Characteristics Of Patients With Coronary Heart Disease And Different Glucose Tolerance Groups

Objective:Diadetes mellitus (DM) was prevalence increasingly year by year,which had become a serious hazard to human health. Diabetes mellitus,cardiovascular diseases and cancer were three common diseases of non-communicable epidemic. Diadetes mellitus was a risk factor for atherosclerosis. The risk of coronary heart disease in patients with type 2 diabetes mellitus (T2DM) was 2 to 4 times higher than non-diabetics. 80% patients of T2DM would occur or die of cardiovascular disease and other major vascular complications. The third report of the National Cholesterol Education Program Adult Treatment Panel (ATPⅢ) made diabetes as a specific risk of coronary heart disease in 2001. In recent years, pre-diabetes stage, known as impaired glucose regulation (IGR), was also considered risk factor for cardiovascular disease. Therefore, this sutdy would explore the influence of blood glucose and other risk factors for coronary heart disease,by means of observing clinical characteristics, laboratory parameters, features of prognosis of coronary angiography in patients with coronary heart disease and different glucose tolerance.Methods:143 cases of coronary heart disease patients confirmed with coronary angiography were selected, who hospitalized in our hospital by the Department of Cardiology. Patients were divided into three groups according to different blood glucose levels, namely simple coronary heart disease group (CHD group) 56 cases (39.1%), coronary heart disease with impaired glucose regulation group (IGR group) 32 cases (22.4%), coronary heart disease with diabetes group (DM group) 55 cases (38.5%). Detailed history, including age, duration, accompanying symptoms, smoking history, drinking history,past medical history, family history were asked, Blood pressure, height, weight were monitored, then body mass index was calculated [BMI = weight (kg) / height~2 ( m~2)]. Patients after admission were probited high-fat diet and strenuous exercise. They were gotten venous blood in the next morning, and then serum total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C), very low density lipoprotein (VLDL-C), lipoprotein (a) ,uric acid (UA) and fasting plasma glucose (FPG) measured. Some of them were evaluted glycosylated hemoglobin, 2hPG and OGTT. All patients were recorded the hospital major adverse cardiac events. Then clinical data, difference in coronary artery disease among the three groups were compared, as well as regression analysis of risk factors.Results:1 Comparison of clinical data: 56 cases(39.1%) involved in the CHD group, 34 male, 22 female, 22 cases with a history of smoking, 37 cases with a history of hypertension, 14 cases with coronary heart disease family history , mean age (63±11) y. 32 cases (22.4%)involved in the IGR group, 16 male, 16 female, 8 cases with smoking history, 17 cases with a history of hypertension, 6 cases with family history of coronary heart disease ,mean age (62±11) y. 55 cases (38.5%) involved in the DM group, 31 male, 24 female, 23 cases with smoking history,41 cases with a history of hypertension, 10 cases with family history of coronary heart disease, mean age (66±8)y. Gender, age, smoking history,family history of CHD,duration of CHD,history of hypertension,body mass index were not statistically significant among three groups. VLDL-C in the DM group was higher than normal values.lipoprotein (a) and LDL-C in the IGR group and DM group was higher than normal values. E/A lower 1 in all three groups. Fasting plasma glucose among the three groups was significantly different (all P<0.01). Compared with the IGR group, glycated hemoglobin level was higher in DM group as well as 2hPG (P<0.05). There were no significant difference in the other indicators among three groups.2 Differences in coronary artery disease:The incidences of single, two, and three of coronary lesions in CHD group were 46.4%, 35.7% and 17.9%,respectivly. The incidences were 18.8%, 37.5% and 43.8% in the IGR group, while they were 18.2%, 25.5 % and 56.4% in DM group.The incidence of single vessel disease in CHD group was significantly higher than that in IGR group and DM group ( both P<0.01), and the incidence of three lesions in the IGR group and the DM group were both significantly higher than that in CHD group (both P<0.01). There was no significant difference in the incidence of two coronary lesions among three groups (P>0.05). Lesions in the LAD branch rates were 71.4%, 93.7% and 96.4% respectivly in CHD, IGR and DM group. Lesions in the LCX branch rates were 41.1%,75% and 67.3% respectivly. Lesions in the RCA branch rates were 58.9%,56.3% and 74.5% respectivly. Lesions in the LM branch rates were14.3%,3.1% and 14.5% respectivly. The disease incidence of LAD and LCX in CHD group were both significantly lower than that in others(both P<0.01). The disease incidence of RCA and LM had no significant differences among three groups(P >0.05).Severe stenosis, diffuse disease, complete occlusion rates in CHD group were 51.8%, 17.9% and 7.1%. The rates in IGR group were 46.9%,43.6% and 0% respectivly. The rates in DM group were 74.5%,45.5% and 18.1% respectivly.Severe stenosis rate in DM group was higher than that in others(both P<0.01). Diffuse disease rates in IGR and DM groups were both higher than that in CHD group(both P<0.01). Complete occlusion rate had no significant differences in DM group and CHD group(P>0.05), there was no case in IGR group.3 Comparison of adverse cardiac events during hospitalization: There were 2 cases of heart failure and 1 case of acute myocardial infarction in CHD group, while there were 2 cases of heart failure and 2 cases of acute myocardial infarction in DM group.There was no adverse cardiac event in IGR group.4 Analysis of coronary heart disease risk factors: Logistic regression analysis showed that duration of diabetes, TC, fasting blood glucose and 2hPG were independent risk factors for three coronary artery disease. Fasting blood glucose and 2hPG were independent risk factors for diffuse coronary artery disease. TC was an independent risk factor for severe coronary artery stenosis progression.Conclusion:1 Coronary artery disease maybe severe and diffuse when coronary heart disease combined with type 2 diabetes, involving poor prognosis.2 Coronary heart disease with impaired glucose regulation can cause diffuse vessel lesions too.3 Fasting blood glucose and 2hPG were the independent risk factors for three coronary artery disease and diffuse coronary artery disease.