ARTERIAL HYPERTENSION AND ATHEROGENIC DYSLIPIDEMIA ARE LEADING RISK FACTORS FOR CORONARY ATHEROSCLEROSIS IN YOUNG AND MIDDLE-AGED IN DIABETIC PATIENTS WITH ACUTE CORONARY SYNDROME

Abstract

Objective: To study the incidence of coronary atherosclerosis in young and middle-aged diabetic (DM) patients with acute coronary syndrome (ACS) against the background of arterial hypertension (AH). Design and method: Seventy-six DM patients admitted with a diagnosis of ACS (59 men,17 women) were included, ages from 36 to 59 years (mean 55.5 years). History of DM less than 1 year in 16 patients; 1-5 years in 24 patients and 5-12 years in 36 patients. The mean of HbA1c was 8.1% (6.2-10.9%). Diagnosed the grade 1 of AH was in 32 (42%) patients; grades 2-3 in 44 (58%) patients. All patients underwent coronary angiography (CAG) with stent implantation in criminal artery. Blood tests for low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C), NT-proBNP, renin, aldosterone, creatinine were performed. As a control group 115 patients (101 men, 14 women) with ACS without diabetes mellitus included, mean age was 54.5 years (37-59 years). Mean of HbA1c was 5.4% (4.9-5.8%). Grade 1 of AH was diagnosed in 72 (62.6%) patients; grade 2-3 in 43 (37.4%) patients. Results: According to CAG, lesions in one vessel of coronary artery (CA) was found in 18 (23.7%) diabetic and in 64 (55.7%) without diabetes patients; lesions in 2 vessels of CA - in 40 (52.6%) diabetic and in 35 (30.4%) without diabetes patients. Lesions in 3 vessels of CA was found in 18 (23.7%) diabetic and in 16 (13.9%) without diabetes patients. The incidence of multivessel CA lesions in diabetic was 76.3% and 44.3% without diabetes patients. LDL-C was 4.14 ± 1.45 mmol/l in diabetes and 3.66 ± 1.26 mmol/l without diabetes (p = 0.0334); HDL-C was 1.30 ± 0.42 mmol/l in diabetes and 1.15 ± 0.32 mmol/l without diabetes (p = 0.0046). In 67.1% diabetic patients and in 52.1% without diabetes renin and aldosterone levels exceeded the norm. NT-proBNP was 880 pg/ml (397-2530 pg/ml) in diabetes had significantly higher than 739 pg/ml (272-1576 pg/ml) without diabetes (p = 0.0001). Conclusions: In young and middle-aged DM patients, arterial hypertension and atherogenic dyslipidemia are the leading risk factors for atherosclerotic CA lesions.