Cardiovascular outcome of patients with abnormal coronary vasomotion and normal coronary arteriography is worse in type 2 diabetes mellitus than in arterial hypertension: a 10 year follow-up study.
Diabetes and arterial hypertension are major cardiovascular risk factors. Coronary endothelial dysfunction is frequently observed in diabetic and hypertensive patients. This study was designed to compare cardiovascular outcome of hypertensive (HT) and type 2 diabetic patients (D2) with angiographically normal coronary arteries on the basis of their epicardial coronary endothelial function. Coronary reactivity assessment by cold-pressor test (CPT) using quantitative coronary angiography was achieved in 65 HT (45 males, 20 females) aged 51.9+/-7.6 years, and in 59 D2 (32 males, 27 females) aged 48.9+/-7.3 years, with angiographically normal coronary arteries and without other major coronary risk factor. Cardiovascular events (CVE) were recorded with a mean follow-up of 108+/-15 months in HT, and 113+/-10 months in D2. During CPT, in HT coronary artery dilation occurred in 10.8% of the patients, no change in 21.5%, and constriction in 67.7%. In D2, dilation occurred in 3.4% of the patients, no change in 18.6%, and constriction in 78.0%. During follow-up, in HT there were nine CVE in 6/65 patients (9.2%), all in the 6/44 (13.6%) patients with coronary artery constriction. In D2, there were 18 CVE in 16/59 patients (27.1%, P<0.01 versus HT), with 17 CVE in the 15/46 patients with coronary artery constriction, and one CVE in the 1/13 patients without constriction (32.6% versus 7.7%). In patients with coronary artery constriction, CVE were more frequent in D2 than in HT (P<0.05). Last, CVE were more severe and occurred earlier in D2 than in HT. In conclusion, epicardial coronary endothelial dysfunction is predictive of long-term CVE in HT and D2 with angiographically normal coronary arteries. Cardiovascular outcome of patients with coronary constriction is worse in D2 than in HT. At the opposite, patients without constriction have good cardiovascular prognosis in both subgroups.
Nitenberg
Alain
A
Service de Physiologie et d'Explorations Fonctionnelles, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique-Hôpitaux de Paris, Université Paris XIII, Avenue du 14 Juillet, 93143 Bondy Cedex, France. alain.nitenberg@jvr.ap-hop-paris.fr
Pham
Isabelle
I
Antony
Isabelle
I
Valensi
Paul
P
Attali
Jean-Raymond
JR
Chemla
Denis
D
D000328:Adult; D000787:Angina Pectoris / Q000453:epidemiology / Q000209:etiology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D003080:Cold Temperature; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D003925:Diabetic Angiopathies / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis; D014661:Vasoconstriction / Q000502:physiology*; D014664:Vasodilation / Q000502:physiology
D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents