Lack of correlation between the optimal glycaemic control and coronary micro vascular dysfunction in patients with diabetes mellitus: a cross sectional study.
BACKGROUND
Coronary microvascular dysfunction (CMD) is associated with cardiovascular events in type 2 diabetes mellitus (T2DM). Optimal glycaemic control does not always preclude future events. We sought to assess the effect of the current target of HBA1c level on the coronary microcirculatory function and identify predictive factors for CMD in T2DM patients.


METHODS
We studied 100 patients with T2DM and 214 patients without T2DM. All of them with a history of chest pain, non-obstructive angiograms and a direct assessment of coronary blood flow increase in response to adenosine and acetylcholine coronary infusion, for evaluation of endothelial independent and dependent CMD. Patients with T2DM were categorized as having optimal (HbA1c < 7%) vs. suboptimal (HbA1c ≥ 7%) glycaemic control at the time of catheterization.


RESULTS
Baseline characteristics and coronary endothelial function parameters differed significantly between T2DM patients and control group. The prevalence of endothelial independent CMD (29.8 vs. 39.6%, p = 0.40) and dependent CMD (61.7 vs. 62.2%, p = 1.00) were similar in patients with optimal vs. suboptimal glycaemic control. Age (OR 1.10; CI 95% 1.04-1.18; p < 0.001) and female gender (OR 3.87; CI 95% 1.45-11.4; p < 0.01) were significantly associated with endothelial independent CMD whereas glomerular filtrate (OR 0.97; CI 95% 0.95-0.99; p < 0.05) was significantly associated with endothelial dependent CMD. The optimal glycaemic control was not associated with endothelial independent (OR 0.60, CI 95% 0.23-1.46; p 0.26) or dependent CMD (OR 0.99, CI 95% 0.43-2.24; p = 0.98).


CONCLUSIONS
The current target of HBA1c level does not predict a better coronary microcirculatory function in T2DM patients. The appropriate strategy for prevention of CMD in T2DM patients remains to be addressed.
Heart Center, Virgen Macarena Hospital, Avenida Doctor Fedriani, nº 3, 41007, Seville, Spain. lfvgmjrh1@yahoo.es.
Luis Felipe
LF
Valenzuela-Garcia
Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. Matsuzawa.Yasushi@gmail.com.
Yasushi
Y
Matsuzawa
Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. Sara.Jaskanwal@mayo.edu.
Jaskanwal D S
JD
Sara
Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. Kwon.TaekGeun@mayo.edu.
Taek-Geun
TG
Kwon
Division of Biomedical Statistics and Informatics, Mayo College of Medicine, 200 First Street SW, Rochester, MN, USA. lennonr@mayo.edu.
Ryan J
RJ
Lennon
Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, USA. Lerman.Lilach@mayo.edu.
Lilach O
LO
Lerman
Heart Center, Virgen Macarena Hospital, Avenida Doctor Fedriani, nº 3, 41007, Seville, Spain. rjruizsalmeron@yahoo.es.
Rafael J
RJ
Ruiz-Salmeron
Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. lerman.amir@mayo.edu.
Amir
A
Lerman
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D015150:Echocardiography, Doppler; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000503:physiopathology*; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human