Impact of glycemic control on the association of endothelial dysfunction and coronary artery disease in patients with type 2 diabetes mellitus

Shuai Chen,Chen-Die Yang,Yang Dai,Feng-Hua Ding,Jing-Meng Liu,Wei-Feng Shen,Xiao-Qun Wang,Yong-Hua Liu,Ying Shen,Lin Lu,Le-Ying Li,Ri Ji,Li-Ping Zhang,Zhi-Ming Wu

doi:10.1186/s12933-021-01257-y

Abstract

BackgroundWe investigated whether glycemic control affects the relation between endothelial dysfunction and coronary artery disease in patients with type 2 diabetes mellitus (T2DM).MethodsIn 102 type 2 diabetic patients with stable angina, endothelial function was evaluated using brachial artery flow-mediated dilation (FMD) with high-resolution ultrasound, and significant stenosis of major epicardial coronary arteries (≥ 50% diameter narrowing) and degree of coronary atherosclerosis (Gensini score and SYNTAX score) were determined. The status of glycemic control was assessed by blood concentration of glycated hemoglobin (HbA1c).ResultsThe prevalence of significant coronary artery stenosis (67.9% vs. 37.0%, P = 0.002) and degree of coronary atherosclerosis (Gensini score: 48.99 ± 48.88 vs. 15.07 ± 21.03, P < 0.001; SYNTAX score: 15.88 ± 16.36 vs. 7.28 ± 10.54, P = 0.003) were higher and FMD was lower (6.03 ± 2.08% vs. 6.94 ± 2.20%, P = 0.036) in diabetic patients with poor glycemic control (HbA1c ≥ 7.0%; n = 56) compared to those with good glycemic control (HbA1c < 7.0%; n = 46). Multivariate regression analysis revealed that tertile of FMD was an independent determinant of presence of significant coronary artery stenosis (OR = 0.227 95% CI 0.056–0.915, P = 0.037), Gensini score (β = − 0.470, P < 0.001) and SYNTAX score (β = − 0.349, P = 0.004) in diabetic patients with poor glycemic control but not for those with good glycemic control (P > 0.05).ConclusionPoor glycemic control negatively influences the association of endothelial dysfunction and coronary artery disease in T2DM patients.

Highlights

We investigated whether glycemic control affects the relation between endothelial dysfunction and coronary artery disease in patients with type 2 diabetes mellitus (T2DM)
We investigated the association of brachial artery flow-mediated dilation (FMD) with angiographic significant coronary artery stenosis and atherosclerosis score in a cohort of type 2 diabetic patients according to the status of glycemic control assessed by blood concentration of glycated hemoglobin (HbA1c)
Angiographic and FMD findings Overall, the prevalence of significant coronary artery disease was higher (67.9% vs. 37.0%, P = 0.002) and the severity of coronary atherosclerosis was more prominent (Gensini score: 48.99 ± 48.88 vs. 15.07 ± 21.03, P < 0.001; SYNTAX score:15.88 ± 16.36 vs. 7.28 ± 10.54, P = 0.003) in patients with poor glycemic control than those with good glycemic control

Summary

Introduction

We investigated whether glycemic control affects the relation between endothelial dysfunction and coronary artery disease in patients with type 2 diabetes mellitus (T2DM). Type 2 diabetes mellitus (T2DM) is independently associated with an increased risk for cardiovascular diseases that is primarily due to the early development of advanced atherosclerotic vascular changes [15]. Endothelial dysfunction has received increasing attention as a potential contributor to the pathogenesis of cardiovascular diseases in type 2 diabetic patients [12, 13, 16]. The mechanisms underlying this phenomenon remain unclear but are likely to be multifactorial. Endothelial dysfunction causes or aggravates T2DM by impairing the timely access of glucose or insulin to target tissues [18]

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