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ECPB 2014, 66(2): 106–111
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Patients with diabetes mellitus type 2 risk factors of coronary heart disease and diabetic cardiomyopathy

Kapustynska О.
Abstract

The study analyzes the impact of risk factors (hyperglycemia, insulin resistance, obesity, dyslipoproteinemia, hypertension, smoking, physical inactivity) in the development of coronary heart disease (CHD) and diabetic cardiomyopathy (DCM) in an integrated survey of 21 diabetic patients (including 16 patients with coronary heart disease and 5 patients with cardiomyopathy). Diagnosis of CHD was carried out under Orders of Ministry of Health of Ukraine № 436 published on 03.07.2006 “On approval of the protocols of care by speciality Cardiology” and the recommendations of the European Society of Cardiology on the diagnosis and treatment of angina pectoris in patients who were not subject to the criteria for coronary heart disease according to the specified order with signs of heart failure, DCM verified. We used the following methods: general (collecting complaints, anthropometric measurements), biochemical (study lipid spectrum of blood, glycaemic hemoglobin, immunoreactive insulin (IRI), glucose), indtrunentary tools (electrocardiography, bicycle ergometry, echocardiography), statistics (by variation statistics using program XLStat 2006). The impact of state compensation of diabetes on the development of CHD and DCM was established, all patients with CHD had uncompensated diabetes (glycaemic hemoglobin – more than 7,5). At the same time, 40% of patients with DCM glycaemic hemoglobin level of less than 7,5. In the 1st group and increased microvascular complications (100% of patients with DCM versus 44,4% in patients with CHD, p<0,05). In the study, we found differences in terms of insulin providing and insulin resistance. In particular, patients with DCM demonstrated more typical hipoinsulinaemia (reduced immunoreactive insulin), while for CHD – insulin resistance.

Virtually all patients with DCM and CHD showed varying degrees of obesity, which was more significant in patients with CHD. Obesity is accompanied with dyslipoproteinaemia, with the dominance of lipoprotein; changes were found in patients with coronary heart disease. In these patients, almost all indicators of lipidogram were higher than that of patients with DCM, except for HDL cholesterol. Most significantly, the statistical reliability of these changes affect the rate of LDL cholesterol – p<0,05. Another important risk factor for coronary heart disease in diabetes mellitus type 2 is hypertension which lasted for more than 5 years. In 89,9% of cases, in patients with coronary heart disease duration of hypertension was over 5 years versus 60% – in patients with dilated cardiomyopathy (p<0,05). The average age of patients in both groups did not significantly differ. Despite the fact that males recognized as an independent predictor of CVD in both cases, diabetics dominated by female patients, however, with DCM were higher (80% vs. 61,1%). The role of smoking in the process of atherogenesis was confirmed. One third of patients with coronary artery disease and diabetes were smokers (29,4% of patients with CHD and 0 smokers in patients with dilated cardiomyopathy). Physical inactivity was more common in patients with dilated cardiomyopathy and probably was associated with greater disease severity and higher number of complications. Thus, the development of coronary heart disease in patients with type 2 diabetes is more mediated by violation compensation of carbohydrate metabolism, insulin resistance, obesity II–III level and increased levels of LDL cholesterol, hypertension (over 5 years) and smoking.

In DCM essential factors are: duration of diabetes, development of microangiopathies and lack of insulin. DCM is more common in females, due to inactivity.

Keywords: diabetes mellitus type 2, coronary artery disease, diabetic cardiomyopathy

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