Publication:

Profile of coronary artery disease cases in diabetics and non-diabetics:a comparative prospective study

Background Diabetes mellitus is one of the commonest disease worldwide ranking next to cardiovascular disorder. The estimated prevalence of diabetes among adults is expected to rise about 100% in future. Cardiac involvement in diabetes commonly manifests as CAD and less commonly as dilated (diabetic) cardiomyopathy and autonomic cardiovascular neuropathy. The risk of CAD among diabetic patients is directly related to the levels of blood pressure, cigarette smoking and total cholesterol.

Methods The present study was undertaken at Chandulal Chandrakar memorial hospital, Bhilai, Chhattisgarh (India) between the periods of September 2010-2012 (2 years). 120 cases of CAD were studied, out of which 60 cases are diabetic CAD and 60 cases are non-diabetic CAD. Sample is drawn by simple random technique. Ethical approval was obtained from institutional ethical committee. Total Cases-120, Diabetic CAD [group – 1]-60 and Non-diabetic CAD [group – 2] – 60.  On recruiting the subjects into Group 1 and Group 2 following protocol is followed-history, clinical examination, pt. stabilization, anthropometric measurement, routine investigations, specific investigations including echocardiography. Procedures, definitions and criteria were used in the study as per standard protocol. In the present study values are expressed as mean ±1 SD. Demographic characteristics of patient with or without diabetes and other unpaired variables were compared.

Results Mean age in diabetic group was (55.7 ± 9.5) years while in non-diabetic group (55.6 ± 9.32) years. Diabetic group consists of 42 males and 18 females. Non Diabetic Group consists of 38 males and 22 females.  Most of the patients in diabetic group presented with chest pain with sweating and with symptoms of sympathetic stimulation (vomiting/ apprehension 83.33%). A small fraction of diabetic patients presented with breathlessness – 20%, syncope (3.33%) and palpitation (8.3%). In diabetic group 55% of patients were hypertensive, pre-HTN was seen in 18.33% and 26.66% had optimal blood pressure. Non-diabetics have higher ideal body weight 58.33% than diabetic (36.66%). Among the diabetic group and non-diabetic group maximum number of cases belonged to low risk category with total cholesterol, triglycerides and LDL cholesterol, but with borderline risk with HDL cholesterol. Diabetics are more vulnerable to mortality than non-diabetics (p<0.05).

Conclusions Diabetics had considerably higher percent of typical and atypical presentation. Hence, CAD should be considered as one of the differential diagnoses in diabetics who have presented with chest pain, however less severe it may be.