Acta Diabetologica

, Volume 48, Issue 3, pp 247–248

Prevalence of diabetes in patients with nonacute CAD

Authors

    • Department of Experimental and Internal MedicineSecond University of Naples
  • Fulvio Furbatto
    • Department of CardiologyUniversity of Naples “Federico II”
  • Ornella Carbonara
    • Department of Experimental and Internal MedicineSecond University of Naples
  • Rodolfo Nasti
    • Department of Experimental and Internal MedicineSecond University of Naples
  • Silvana Morra
    • Department of Experimental and Internal MedicineSecond University of Naples
  • Roberto Torella
    • Department of Experimental and Internal MedicineSecond University of Naples
  • Federico Piscione
    • Department of CardiologyUniversity of Naples “Federico II”
Letter to the Editor

DOI: 10.1007/s00592-011-0263-3

Cite this article as:
Sasso, F.C., Furbatto, F., Carbonara, O. et al. Acta Diabetol (2011) 48: 247. doi:10.1007/s00592-011-0263-3
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Dear Sir

The relationship between coronary artery disease (CAD) and diabetes is widely documented [13], and diabetic patients present a worse CV outcome in respect to nondiabetic patients [4].

Recently, the physiopathology of CV risk in patients affected by undiagnosed or newly detected diabetes is matter of great interest [5, 6].

Actually, the prevalence of diabetes in CAD patients is not clearly estimated because diagnosis is generally based on not exhaustive criteria, such as history of diabetes or hyperglycemia during acute events.

We aimed to evaluate the true prevalence of diabetes in nonacute patients affected by CAD, as assessed by coronary angiography.

Six hundred and seventy nine patients admitted from November 2008 to November 2009 in the Cardiology Ward of University of Naples to perform angiography for suspect CAD were assessed for eligibility.

Patients with coronary acute events in the last 4 week and subjects without angiographically detectable CAD were excluded. Moreover, treatment with steroids, acute infections, fever, or any condition that could impair glycemic metabolism were further exclusion criteria. Finally, 510 Caucasian patients (301M, 209F; age 57 ± 13 years) were eligible. Ninety seven (19%) had known diabetes (history and/or use of antidiabetic agents or newly discovered by fasting glucose value ≥126 mg/dl). The other 413 were submitted to standardized oral glucose test tolerance (OGTT), repeated twice in case of abnormal response [7]. Diabetes was revealed in 151 subjects, while 72 were affected by prediabetes, a condition at high risk to develop overt diabetes. Thus, the overall prevalence of diabetes was 48.6%, and the prevalence of glycemic impairments (diabetes plus prediabetes) was 62.7%. Only 190 (37.2%) showed a normal glucose tolerance (Fig. 1).
https://static-content.springer.com/image/art%3A10.1007%2Fs00592-011-0263-3/MediaObjects/592_2011_263_Fig1_HTML.gif
Fig. 1

Flow chart of the study. IGT impaired glucose tolerance, IFG impaired fasting glucose, and NGT normal glucose tolerance

The number of vessels with obstructive plaque (≥50% lumen narrowing) was higher in diabetic than in nondiabetic group (1.12 ± 1.13 vs. 1.68 ± 1.33; P < 0.01), confirming that it is clinically crucial to make diagnosis of diabetes. Within diabetic subjects, the number of stenosed vessels was similar in all quintiles of HbA1c, thus vessel involvement appears independent of glycemic control. No significant difference was observed in the number of stenosed vessels between prediabetes group and normoglycemic group. Quantitative coronary angiography did not show a significant difference between diabetic and nondiabetic group (prevalence of type B2-C lesions, respectively, 85.6% vs. 82.6%, P = ns).

In our study, OGTT permitted to identify an overall prevalence of diabetes in CAD subjects 2.5-fold higher than the sole history and/or fasting glucose values did. Therefore, we suggest to perform OGTT in all the patients affected by CHD to identify most unknown diabetes and improve CV outcome by adequate therapy [8].

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© Springer-Verlag 2011