[Adiponectinemia, inflammatory process activity, and endothelial dysfunction in patients with type 2 diabetes and acute coronary syndrome with ST elevation in relation to the severity of lesions in the coronary arteries].
BACKGROUND
Metabolic disorders developing in diabetes are associated with impaired endothelial function and the presence of subclinical inflammation, in consequence leading to generalized atherosclerosis. Vasoprotective factors include adiponectin, a cytokine with a diverse antiatherosclerotic activity.


OBJECTIVE
Evaluation of adiponectin concentrations and activity of the inflammatory process and endothelial dysfunction in patients with type 2 diabetes and acute coronary syndrome (ACS) with ST elevation (STEMI) in relation to the severity of lesions in the coronary arteries.


METHODS
This study included 72 patients (24 women, 48 men) with type 2 diabetes, treated with sulphonylurea derivatives, diagnosed with STEMI, who underwent percutaneous coronary angioplasty. The treated group consisted of 41 patients, mean age (+/- standard deviation) was 64 +/-9.6 years, the Gensini score (GS) >32 points (more advanced lesions in the coronary vessels). The control group consisted of 31 patients, a mean age of 63 +/-10 years, GS <32 points (less advanced lesions). Within 12 hours after the ACS, serum troponin T activity (TnT), creatine kinase MB isoenzyme (CK-MB), C-reactive protein (CRP), fibrinogen, two adhesion molecules - soluble vascular adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesive molecule-1 (sICAM-1) were evaluated in serum of the patients. Leucocytosis, glucose and insulin levels, and lipid profiles were obtained after overnight fast conditions.


RESULTS
Patients in group I demonstrated a significantly higher TnT and CK-MB (1.39 +/-1.3 vs 0.83 +/-0.74 ng/ml, p <0.05; 139.6 +/-178.5 vs 57.48+/-52.1 IU/I p <0.05, respectively), higher concentrations of CRP (12.06 +/-14.3 vs 3.59 +/-4.1mg/l, p <0.05) fibrinogen (4.59 +/-1.93 vs 3.62 +/-1.36 g/l, p <0.05), sVCAM-1 (1393.4 +/-865.4 vs 863.9+/-425.2 ng/ml, p <0.05) and sICAM-1 (735.1+/-316.3 vs 573.3 +/-226.1 ng/ml, p <0.05), higher leucocytosis (11,430 +/-3680 vs 9750+/-3100/microl, p <0.05) and lower adiponectin concentrations (5.8 +/-5.2 vs 8.3 +/-2.9 8 microg/ml, p <0.05) as compared to the control group.


CONCLUSIONS
Hypoadiponectinaemia, severity of the inflammatory process and endothelial dysfunction could be factors contributing to the progression of atherosclerotic lesions in the coronary arteries in patients with type 2 diabetes.
Miłosz
Danuta
D
Klinika Diabetologii i Chorób Metabolicznych, Uniwersytet Medyczny, łódź. dmilosz@poczta.fm
Czupryniak
Leszek
L
Saryusz-Wolska
Małgorzata
M
Zasadzińska
Grazyna
G
Borkowska
Anna
A
Cieplucha
Elzbieta
E
Chizyński
Krzysztof
K
Loba
Jerzy
J
D054058:Acute Coronary Syndrome / Q000097:blood / Q000209:etiology*; D052242:Adiponectin / Q000097:blood*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D050197:Atherosclerosis / Q000097:blood / Q000150:complications; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D052279:Creatine Kinase, MB Form / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications*; D042783:Endothelial Cells / Q000378:metabolism*; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000150:complications; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020107:Troponin T / Q000097:blood; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
D052242:Adiponectin; D015415:Biomarkers; D020107:Troponin T; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D005340:Fibrinogen; D002097:C-Reactive Protein; D052279:Creatine Kinase, MB Form