Silent coronary heart disease in patients with type 2 diabetes: application of a screening approach in a follow-up study

Silent coronary artery disease in type 2 diabetes: a narrative review on epidemiology, risk factors, and clinical studies

Silent coronary artery disease (CAD) is one of the manifestations of heart disease that particularly affects subjects with type 2 diabetes mellitus (T2DM). From a clinical point of view, silent CAD represents a constant challenge for the diabetologist, who has to decide whether a patient could or could not be screened for this disease. In the present narrative review, several aspects of silent CAD are considered: the epidemiology of the disease, the associated risk factors, and main studies conducted, in the last 20 years, especially aimed to demonstrate the usefulness of the screening of silent CAD, to improve cardiovascular outcomes in type 2 diabetes.

Practical cardiovascular risk calculator for asymptomatic patients with type 2 diabetes mellitus: PRECISE-DM risk score

BACKGROUND

Obstructive coronary artery disease (OCAD) is a significant predictor of adverse clinical events in asymptomatic patients with type 2 diabetes mellitus (T2DM).

HYPOTHESIS

We sought to develop an easy-to-use risk scoring system to predict OCAD and long-term clinical outcome in asymptomatic patients with T2DM (PRECISE-DM).

METHODS

A total of 2799 asymptomatic patients with T2DM and no prior coronary disease were consecutively enrolled. OCAD was defined as ≥50% coronary artery stenosis on coronary computed tomography angiography (CCTA). A new risk scoring system was developed in 933 patients undergoing CCTA (derivation cohort) and its performance to predict OCAD and major adverse cardiac and cerebrovascular event (MACCE) was compared with other risk estimates. The scoring system was externally validated in 1899 patients not undergoing CCTA (validation cohort).

RESULTS

The PRECISE-DM scoring system was created using seven variables that were associated with increased risk of OCAD, with scores ranging from 0 to 9. The scoring system predicted presence of OCAD with a C-statistic of 0.680 and risk of MACCE with a C-statistic of 0.708. The UKPDS risk engine and the Framingham risk score showed unreliable performance in prediction of OCAD (C-statistics 0.531 and 0.577, respectively). Calcium score was highly predictive for OCAD (C-statistic 0.825) but showed only modest accuracy in predicting MACCE (C-statistic 0.675). In the external validation cohort, the PRECISE-DM score showed acceptable discrimination for prediction of MACCE (C-statistic 0.707).

CONCLUSIONS

The PRECISE-DM scoring system accurately predicted presence of OCAD and risk of MACCE in asymptomatic patients with T2DM.

Allostatic load in the association of depressive symptoms with incident coronary heart disease: The Jackson Heart Study

African Americans are at heightened risk for coronary heart disease (CHD), with biologic pathways poorly understood. We examined the role of allostatic load (AL) in the association of depressive symptoms with incident CHD among 2,670 African American men and women in the prospective Jackson Heart Study. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CES-D). Incident CHD was ascertained by self-report, death certificate survey, and adjudicated medical record surveillance. Baseline AL was quantified using biologic parameters of metabolic, cardiovascular, immune, and neuroendocrine subsystems and as a combined meta-factor. Sequential models adjusted for demographic, socioeconomic, and behavioral covariates, stratified to examine differences by sex. Greater depressive symptomatology was associated with greater metabolic, cardiovascular, and immune AL (p-values≤0.036) and AL meta-factor z-scores (p = 0.007), with findings driven by observations among females. Each 1-point increase in baseline depressive symptomatology, and 1-SD increase in metabolic AL, neuroendocrine AL, and AL meta-factor z-scores was associated with 3.3%, 88%, 39%, and 130% increases in CHD risk, respectively (p-values <0.001). Neuroendocrine AL and AL meta-factor scores predicted incident CHD among males but not females in stratified analyses. Metabolic AL partially mediated the association of depressive symptoms with incident CHD (5.79% mediation, p = 0.044), a finding present among females (p = 0.016) but not males (p = 0.840). Among African American adults, we present novel findings of an association between depressive symptomatology and incident CHD, partially mediated by metabolic AL. These findings appear to be unique to females, an important consideration in the design of targeted interventions for CHD prevention.

Expression and influence of pentraxin-3, HbAlc and ApoA1/ApoB in serum of patients with acute myocardial infarction combined with diabetes mellitus type 2

The present study investigated the clinical significance of changes in levels of hypersensitive plasma pentraxin-3 (PTX3), hemoglobin A1c (HbAlc) and apolipoprotein A-I (ApoA1)/apolipoprotein B (ApoB) on patients with acute myocardial infarction (AMI) and diabetes mellitus type 2 (T2DM). After admission, 100 patients diagnosed with AMI combined with T2DM were selected as Group A. According to the level of fasting blood glucose (FBG), they were then subdivided into Group A1 (n=44) with FBG ≥13.0 mmol/l and Group A2 (n=56) with FBG <13.0 mmol/l. A total of 100 hospitalized patients with AMI in People's Hospital of Dongying (Dongying, China) were collected as Group B, and 100 healthy people receiving physical examination in the Physical Examination Center of People's Hospital of Dongying were selected as Group C. Serum PTX3, HbAlc and ApoA1/ApoB of all the study participants were tested, and diseased coronary artery vessels were divided into single-, double- and triple-vessel lesions according to their numbers. Logistic regression analysis was performed for the number of diseased coronary artery vessels and each index. The level of PTX3 in Group A1 was higher than that in Group A2; the level of ApoA1/ApoB in the former was lower than that in the latter (P<0.05); and the level of HbAlc in the former was significantly higher than that in the latter (P<0.01); the levels of PTX3 and HbA1c in Group A2 were higher than those in Group B, while the level of ApoA1/ApoB in the former was lower than that in the latter (P<0.05). Logistic regression analysis showed that the number of diseased coronary artery vessels was positively correlated with PTX3 and HbA1c, but negatively correlated with ApoA1/ApoB. PTX3, HbAlc and ApoA1/apoB have a certain clinical significance in assessing the severity of AMI combined with T2DM.