PROGNOSTIC FACTORS OF CHRONIC CORONARY SYNDROME IN PATIENTS WITH CONCOMITANT TYPE 2 DIABETES MELLITUS

Abstract

Introduction: Chronic coronary syndrome (CCS) with concomitant type 2 diabetes mellitus (T2DM) is still a major cause of disability and mortality. That is why studying the prognostic factors of combination of these diseases is very relevant. There are many researches regarding the inflammation component of the development of atherosclerosis in patients with CCS and T2DM. It is still unknown how exactly does chronic systemic inflammation influences cardiac remodeling in such patients. The Aim: Considering the aforementioned, the aim of our study was to asses the prognostic role of serum sST2, highsensitive C-reactive protein (hs-CRP) and TMAO as markers of chronic systemic inflammation and ins insulin resistance in patients with CCS and T2DM. Material and methods: 90 patients were enrolled, among them 30 patients with CCS: stable angina, class ІІ-ІІІ (group І) and 60 patients with CCS: stable angina, class ІІ-ІІІ and T2DM, non-insulin-requiring (group ІІ). The study was performed in Ivano-Frankivsk Central City Hospital and City Hospital No 1 (Ukraine) in accordance with the Helsinki Declaration and Good Clinical Practice Guideline. All patients gave written informed consent and the local ethics committee approved the study protocol. The patients were tested for the following: glycated hemoglobin (НbА1c), total plasma cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL), low and very low density lipoproteins (LDL and VLDL), TMAO, sST2, hs-CRP. Results and discussion: Patients with CCS and concomitant T2DM have higher levels of markers of systemic inflammation response, including TMAO by 8.5 times, sST2 by 2.2, hs-CRP by 19.1, compared with healthy individuals. Conclusions: Patients with CCS and concomitant T2DM have more “atherogenic” dyslipidemia compared with the patients with isolated CCS, including statistically significant higher levels of triglycerides (р<0.05), VLDL (р<0.05), and atherogenicity index of plasma (AIP) (р<0.05), and lower level of HDL(р<0.05). Results of this study suggest the possible use of ST2 as diagnostic and prognostic marker in patients with stable angina, including patients with concomitant T2DM. ST2 level > 35 ng/mL is negative prognostic marker concerning the development of chronic heart failure and testament for the need of more thorough examination of such patients. The level of TMAO can also be another credible predictor of negative prognosis of CCS.