title: Type 2 diabetes mellitus and myocardial ischemic preconditioning in symptomatic coronary artery disease patients.
abstract: BACKGROUND
  The influence of diabetes mellitus on myocardial ischemic preconditioning is not clearly defined. Experimental studies are conflicting and human studies are scarce and inconclusive.
  
  
  OBJECTIVE
  Identify whether diabetes mellitus intervenes on ischemic preconditioning in symptomatic coronary artery disease patients.
  
  
  METHODS
  Symptomatic multivessel coronary artery disease patients with preserved systolic ventricular function and a positive exercise test underwent two sequential exercise tests to demonstrate ischemic preconditioning. Ischemic parameters were compared among patients with and without type 2 diabetes mellitus. Ischemic preconditioning was considered present when the time to 1.0 mm ST deviation and rate pressure-product were greater in the second of 2 exercise tests. Sequential exercise tests were analyzed by 2 independent cardiologists.
  
  
  RESULTS
  Of the 2,140 consecutive coronary artery disease patients screened, 361 met inclusion criteria, and 174 patients (64.2 ± 7.6 years) completed the study protocol. Of these, 86 had the diagnosis of type 2 diabetes. Among diabetic patients, 62 (72 %) manifested an improvement in ischemic parameters consistent with ischemic preconditioning, whereas among nondiabetic patients, 60 (68 %) manifested ischemic preconditioning (p = 0.62). The analysis of patients who demonstrated ischemic preconditioning showed similar improvement in the time to 1.0 mm ST deviation between diabetic and nondiabetic groups (79.4 ± 47.6 vs 65.5 ± 36.4 s, respectively, p = 0.12). Regarding rate pressure-product, the improvement was greater in diabetic compared to nondiabetic patients (3011 ± 2430 vs 2081 ± 2139 bpm x mmHg, respectively, p = 0.01).
  
  
  CONCLUSIONS
  In this study, diabetes mellitus was not associated with impairment in ischemic preconditioning in symptomatic coronary artery disease patients. Furthermore, diabetic patients experienced an improvement in this significant mechanism of myocardial protection.
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. rezendepaulo@hotmail.com.
authors.forename: Paulo Cury
authors.initials: PC
authors.lastname: Rezende
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. rosarahmi@gmail.com.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Rahmi
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. augusto.uchida@gmail.com.
authors.forename: Augusto Hiroshi
authors.initials: AH
authors.lastname: Uchida
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. leandro1910@uol.com.br.
authors.forename: Leandro Menezes Alves
authors.initials: LM
authors.lastname: da Costa
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. tlscud@ig.com.br.
authors.forename: Thiago Luis
authors.initials: TL
authors.lastname: Scudeler
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. clg_rose@yahoo.com.
authors.forename: Cibele Larrosa
authors.initials: CL
authors.lastname: Garzillo
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. eduglima@yahoo.com.br.
authors.forename: Eduardo Gomes
authors.initials: EG
authors.lastname: Lima
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. alexandre.segre@terra.com.br.
authors.forename: Carlos Alexandre Wainrober
authors.initials: CA
authors.lastname: Segre
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. prigirardi@hotmail.com.
authors.forename: Priscyla
authors.initials: P
authors.lastname: Girardi
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. myrthes.takiuti@hc.fm.usp.br.
authors.forename: Myrthes
authors.initials: M
authors.lastname: Takiuti
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. marcela.silva@incor.usp.br.
authors.forename: Marcela Francisca
authors.initials: MF
authors.lastname: Silva
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. whady.hueb@incor.usp.br.
authors.forename: Whady
authors.initials: W
authors.lastname: Hueb
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. jose.ramires@incor.usp.br.
authors.forename: Jose Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, 05403-000, Cerqueira César, São Paulo, Brazil. kalil@uol.com.br.
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000150:complications / Q000503:physiopathology*; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies