Relevance of hemostatic risk factors on coronary morphology in patients with diabetes mellitus type 2.
OBJECTIVE
The influence hemostatitc parameters on the morphological extent and severity of coronary artery disease were studied in patients with and without DM type 2.


BACKGROUND
It is known that patients with diabetes (DM) have abnormal metabolic and hemostatic parameters


METHODS
Of 150 consecutive patients with angiographically proven coronary artery disease 29 presented with DM. Additionally to parameters of lipid-metabolism fibrinogen, tissue-plasminogenactivator (t-PA), plasminogen-activator-inhibitor (PAI), plasmin-a-antiplasmin (PAP), prothrombin-fragment 1+2 (F1+2), thrombin-antithrombin (TAT), von-willebrand-factor (vWF), platelet factor 4 (PF4), glykomembranproteine 140 (GMP140) and the rheologic parameters plasma viscosity and red blood cell aggregation were evaluated. The extent and severity of CAD was evaluated according to the criteria of the American Heart Association.


RESULTS
Patients with DM presented with a higher number of conventional risk factors as compared to non-diabetic patients. Additionally there were significant differences for F1+2, red blood cell aggregation and PAI. Diabetic patients showed a more severe extent of coronary arteriosclerosis, which also could be found more distally. A significant relationship between blood-glucose, thrombocyte-activation (vWF), endogenous fibrinolysis (PAI) and the severity of CAD and a more distal location of stenoses could be found (r = 0.6, p < 0.001).


CONCLUSIONS
Patients with coronary artery disease and DM type 2 showed marked alterations of metabolic, hemostatic, fibrinolytic and rheologic parameters, which can produce a prothrombogenic state. A direct association of thrombogenic factors on coronary morphology could be shown. This can be the pathophysiologic mechanism of more severe and distal pronounced coronary atherosclerosis in these patients.
Profil Institut für Stoffwechselforschung, Division of Cardiometabolic Research, Neuss, Germany. thomas.jax@profil-research.de
Thomas W
TW
Jax
Ansgar J
AJ
Peters
Gunnar
G
Plehn
Frank-Chris
FC
Schoebel
D000368:Aged; D003324:Coronary Artery Disease / Q000097:blood* / Q000209:etiology* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications*; D003925:Diabetic Angiopathies / Q000097:blood / Q000209:etiology / Q000473:pathology; D005342:Fibrinolysis; D018056:Hemorheology; D006487:Hemostasis; D006801:Humans; D008875:Middle Aged; D015539:Platelet Activation; D012307:Risk Factors