Третий этап кардиореабилитации после перенесенного острого коронарного синдрома: распространенность сахарного диабета и его факторов риска

Abstract

Aim: to determine risk factors for type 2 diabetes (T2D) in patients with the prior acute coronary syndrome (ACS) in the 3rd phase of cardiac rehabilitation. Patients and Methods: retrospective analysis of medical records of 200 patients (151 men, 75.5%) was performed. The mean age was 61.7±9.6 years. All patients attended a 12-month cardiac rehab program that included adequate pharmacotherapy (atorvastatin monotherapy or atorvastatin plus ezetimibe), physical and psychological rehabilitation, therapeutic feeding, and preventive group consultations (health schools). Both quantitative (fasting blood glucose, weight, body mass index, waist circumference, hip circumference, a body shape index) and qualitative (overweight, obesity, other risk factors for T2D, diabetes, de novo diabetes) parameters were studied. Results: in patients with prior ACS, a high prevalence of conventional and additional risk factors for T2D (≥ 6 risk factors were revealed in 90% of patients) was reported in the 3rd phase of cardiac rehab. After completing the cardiac rehab program, the prevalence of T2D in patients with prior ACS was 24% thereby demonstrating a significant increase (p < 0.05). Additionally, a significant increase in the proportion of patients with high normal blood glucose (5.0–6.0 mmol/l) was reported. Unfavorable de novo abnormalities of carbohydrate metabolism (pre-diabetes, T2D plus pre-diabetes) were commonly revealed in patients with high normal blood glucose. Cardiac rehab program provided weight control in patients with T2D risk. A significant increase in waist circumference, a body shape index, the waist-to-height ratio was reported thus demonstrating redistribution of fat mass and an increase in visceral fat. These signs may indicate an unfavorable trend of increased insulin resistance. Conclusions: searching for risk factors of unfavorable metabolic abnormalities identified and means to optimize management of these patients (including medical treatment) based on the assessment of metabolic benefits and drawbacks is required. KEYWORDS: acute coronary syndrome, cardiac rehabilitation, type 2 diabetes, pre-diabetes, insulin resistance, risk factors, statins. FOR CITATION: Druk I.V., Korennova O.Yu., Savchenko M.V. et al. Third phase of cardiac rehabilitation after acute coronary syndrome: prevalence of diabetes and its risk factors. Russian Medical Inquiry. 2021;5(4):176–184 (in Russ.). DOI: 10.32364/2587-6821-2021- 5-4-176-184.