Ruptured plaque

Cardiovascular disease and type 2 diabetes mellitus: a multifaceted symbiosis

Chronic hyperglycaemia (e.g. type 2 diabetes mellitus (T2DM) and prediabetes) in humans is associated with an increased risk of cardiovascular (CV) complications, and, vice versa, the presence of CV complications (e.g. myocardial infarction, stroke or intermittent claudication) among patients heightens the risk of T2DM or prediabetes. In both cases (i.e. chronic hyperglycaemia and CV complications), significant diagnostic and treatment challenges resulting from a broad range of factors may serve as barriers to reducing the deleterious societal impact of T2DM and prediabetes. These challenges often include clinicians: failing to intervene early and aggressively enough among patients with T2DM to achieve CV risk factor control; failing to efficaciously identify T2DM patients with already established CV complications; and failing proactively to assess individuals at high risk for T2DM. This review discusses the apparent symbiosis between CV disease and T2DM, with a focus on identifying patients with established T2DM or at risk for T2DM; traditional and novel risk factors and markers for CV disease in T2DM; challenges related to diagnosing CV disease in T2DM; and organization of T2DM care in order to prevent CV complications. These are issues that require attention because identifying patients at high risk for T2DM can halt or reduce their further glycaemic deterioration if addressed properly, and because novel markers and non-invasive tests could be applied in patients with T2DM as a means of detecting and possibly treating unrecognized CV disease in time. Furthermore, several approaches for T2DM care can be effective in controlling the CV risk factors contributing to CV complications.

Heart rate adjustments and analysis of recovery patterns of ST-segment depression in type 2 diabetes

AIMS

To investigate the diagnostic value for coronary artery disease (CAD) detection of evaluating time- and heart rate (HR)-related ST-segment changes (the ST/HR-slope) and the post-exercise recovery pattern (the ST/HR-recovery loop) in patients with type 2 diabetes mellitus (T2DM).

METHODS AND RESULTS

Ninety-one patients (22 female, age 59+/-9 years) with T2DM (diabetes duration 6+/-6 years) performed an exercise ECG-test that was evaluated using the ST/HR slope (cut-off</=-2.4 microV/bpm) and -recovery loop patterns (abnormal versus normal) and compared to the conventional >/=1 mm ST-segment depression criterion and dobutamine stress echo-cardiography, all evaluated against coronary angiography irrespective of stress test results. Coronary angiography revealed CAD in 20 men and 3 women (25%). Sensitivity for the conventional exercise test and stress echocardiography was low (0.35 and 0.30), but increased significantly using the ST/HR-slope (0.45), the recovery loop (0.86) or the combined ST/HR slope and recovery loop criterion (0.91). The associations between angiographic CAD-detection and the different tests expressed by the Odds ratio demonstrated an added value of performing ST/HR analysis both over pre-test CAD risk profile and the established techniques.

CONCLUSION

T2DM patients capable of performing an exercise test could be assessed with the ST/HR-analysis for selecting patients to angiography. However, further studies including a higher number of patients are needed to confirm the diagnostic value of this approach.