Prognostic signs of an unfavorable course of coronary heart disease in patients with type 2 diabetes mellitus

• Main Authors: Yu.M. Urmanova, Sh.Sh. Mukhtarova, A.B. Grossman, M.Z. Mukhtarova, R.Kh. Trigulova
• Format: Article
• Language: English
• Published: Publishing House Zaslavsky 2020-03-01
• Series: Mìžnarodnij Endokrinologìčnij Žurnal
• Subjects: type 2 diabetes mellitus; coronary heart disease; risk factors
• Online Access: http://iej.zaslavsky.com.ua/article/view/201293
• ISSN: 2224-0721; 2307-1427

Background. Despite the successful development of medical technologies in the diagnosis of coronary heart disease, mortality due to cardiovascular diseases in the population of patients with diabetes mellitus (DM) is not reduced. The development of an algorithm for the early diagnosis of coronary heart di­sease and ways to correct it is a topical problem of cardiology and endocrinology. The purpose is to determine prognostic signs for an unfavorable course of coronary heart disease and develop a table of test probabilities in order to enhance the effectiveness of risk stratification in patients with type 2 DM. Materials and methods. During 2017–2019, there were observed 40 patients (16 men and 24 women) with type 2 DM in combination with coronary heart disease. We took into account the presence of acute myocardial infarction, acute cerebrovascular accidents (stroke), repeated surgical interventions (percutaneous coronary intervention, coronary artery bypass grafting) for the last 3 years. The average age of patients was 65.5 years. Results. In total, 119 signs recorded in the first three days from the moment of patient’s admission were analyzed as possible predictors of an unfavorable prognosis. As markers of coronary heart disease, parameters were adopted that showed the highest occurrence in the group of patients with adverse course of DM and coronary heart disease. The most patho­gnomonic predictors of coronary heart disease progression in patients with type 2 DM were left ventricular systolic dysfunction (ejection fraction < 40 %), systolic blood pressure > 160 mmHg or diastolic blood pressure above 100 mmHg, electrocardiographic signs of myocardial ischemia, persisting upon discharge from the hospital. Conclusions. Criteria that negatively affect the long-term outcome of coronary heart disease in patients with type 2 diabetes are decompensation of DM, in particular, a high level of fasting glycemia (> 13 mmol/l), as well as an increase in total cholesterol and low-density lipoprotein cholesterol.