Association of glycosylated haemoglobin level and diabetes mellitus duration with the severity of coronary artery disease

Abstract

Diabetes mellitus (DM) is known to cause microvascular and possibly macrovascular complications. This study was performed to find the association between glycosylated haemoglobin (HbA_1C) level and the severity of coronary artery disease. One hundred and ten consecutive patients admitted to hospital with acute myocardial infarction were studied. Seventy-eight patients (70.9%) had DM, 73 (93.58%) had HbA_1C > 7%, 52 (47.3%) were hypertensive, 19 (17.3%) had a history of smoking and 37 (33.6%) had raised cholesterol. Coronary angiography was carried out in 87 (79.1%) patients and the severity of disease was assessed using the Gensini score. The mean Gensini score was 53.36±36.94 and the mean HbA_1C was 8.4±2.39%. There was a significant association between Gensini score and DM (p=0.003) and between Gensini score and hypertension (p=0.018). HbA_1C (r=0.427, p=0.001) and duration of DM (r=0.362, p=0.004) had a positive linear correlation with the Gensini score. Multiple regression analysis showed HbA_1C to be an independent factor that influenced the Gensini score (p=0.021).

Keywords

diabetes mellitus Gensini score HbA1C severity of coronary artery disease

References

1. Donnelly R Emslie-Smith AM , Gardner ID. Vascular complications of diabetes. BMJ 2000;320:1062–6.

2. Al-Nozha MM , Al-Maatouq MA , Al-Mazrou YY et al. Diabetes mellitus in Saudi Arabia. Saudi Med J 2004;25(11):1603–10.

3. United Kingdom Prospective Diabetes Study (UKPDS) group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837–53.

4. Rossing P Hougaard P , Borch-Johnsen K , Parving HH. Predictors of mortality in insulin dependent diabetes: 10 years observational follow up study. BMJ 1996;313:779–84.

5. Gall MA Borch-Johnsen K , Hougaard P , Nielsen FS , Parving HH. Albuminuria and poor glycemic control predict mortality in NIDDM. Diabetes 1995;44:1303–09.

6. American Diabetes Association.

Standard of medical care in diabetes (position statement).

Diabetes Care 2007;30:S4–S41.

7. American Diabetes Association.

Implications of the United Kingdom Prospective Diabetes Study (position statement).

Diabetes Care 2002;25:S28–S32.

8. Khaw KT Wareham N , Bingham S , Luben R , Welch A , Day N. Association of haemoglobin A1C with cardiovascular disease and mortality in adults: The European Prospective Investigation into Cancer in Norfolk. Ann Intern Med 2004;141:413–20.

9. Khaw KT Wareham N , Luben R et al. Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and nutrition (EPIC-Norfolk). BMJ 2001;322:15–18.

10.

10. Selvin E Marinopoulos S , Berkenblit G et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004;141:421–31.

11.

11. The Diabetes Control and Complications Trial research group. The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin dependent diabetes mellitus. N Engl J Med 1993;329:977–86.

12.

12. Kiuchi K Nejima J , Takano T , Ohta M , Hashimoto H. Increased serum concentrations of advanced glycation end products: a marker of coronary artery disease activity in type 2 diabetic patients. Heart 2001;85:87–91.

13.

13. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.

14.

14. Jia E Yang Z , Zhu T et al. Serum sodium concentration is significantly associated with the angiographic characteristics of coronary atherosclerosis. Acta Pharmacologica Sinica 2007;28:1136–42.

15.

15. Cay S Metin F , Korkmaz S. Association of renal functional impairment and the severity of coronary artery disease. Anadolu Kardiyol Derg 2007;7:44–8.

16.

16. Kataoka Y Yasuda S , Morii I , Otsuka Y , Kawamura A , Miyazaki S. Quantitative coronary angiographic studies of patients with angina pectoris and impaired glucose tolerance. Diabetes Care 2005;28:2217–22.

17.

17. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS38). BMJ 1998;317:703–13.

18.

18. Grossman E Messerli HF. Hypertension and diabetes. Adv Cardiol 2008;45:82–106.

19.

19. Marshall SM. Blood pressure control, microalbuminuria and cardiovascular risks in type 2 diabetes mellitus. Diabet Med 1999;16:358–72.

20.

20. American Diabetes Association.

Hypertension management in adults with diabetes (position statement).

Diabetes Care 2004;27:S65–S67.

21.

21. Arauz-Pacheco C , Parrott MA , Raskin P. The treatment of hypertension in adult patients with diabetes (technical review). Diabetes Care 2002;25:134–47.

22.

22. Beckman JA Libby P , Creagar AM. Diabetes mellitus, the metabolic syndrome, and atherosclerotic vascular disease In: DP Zipes , P Libby , RO Bonow , E Braunwald , eds. Braunwald's heart disease, a text book of cardiovascular medicine 7th edition. Elsevier Inc., Pennsylvania, Philadelphia, 2005;1035–43.