Abstract
The risk factors for asymptomatic coronary artery disease (CAD) were examined in 138 diabetic patients. Following non-invasive screening examinations (exercise electrocardiography, dynamic thallium scintigraphy, 24-h electrocardiographic recording), CAD was confirmed angiographically in 21 symptom-free diabetic subjects with an ischaemic finding in at least one of the non-invasive tests. The prevalence of asymptomatic CAD in this cohort of diabetic patients was 21/132 (16%), which may be an underestimation because 6 patients refused angiography. Risk factors (age, diabetes, smoking, hypertension, serum lipoproteins, apoproteins and apo E phenotypes) were analysed according to the presence or absence of CAD. Multivariate logistic stepwise analysis did not show any definite changes of serum lipids, lipoproteins and apoproteins in type 1 (n=72) and type 2 (n=66) diabetic patients with or without asymptomatic CAD. The only factors associated with asymptomatic CAD were the duration of diabetes (P<0.005) and the age of the patient (P<0.05). These results suggest that in diabetic patients the major risk factor for premature coronary atherosclerosis is diabetes itself. Assessment of other risk factors does not seem to define any subgroup with asymptomatic CAD.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Partamian JO, Bradley RF, Acute myocardial infarction in 258 cases of diabetes. Immediate mortality and five-year-survival. N Engl J Med 273:455–461, 1965
Soler NG, Benner MA, Pentecost BL, Fitzgerald MG, Malius JM, Myocardial infarction in diabetics. Q J Med 44:125–132, 1975
Koistinen MJ, Prevalence of asymptomatic myocardial ischaemia in diabetic subjects. BMJ 301:92–95, 1990
Feingold KR, Siperstein MD, Diabetic vascular disease. Adv Intern Med 31:309–340, 1986
Pyörälä K, Laakso M, Uusitupa M, Diabetes and atherosclerosis: an epidemiological view. Diabetes Metab Rev 3:463–524, 1987
Mühlhauser I, Smoking and diabetes. Diabetic Med 7:10–15, 1990
Betteridge DJ, Lipids, diabetes, and vascular disease: the time to act. Diabetic Med 6:195–218, 1989
Merrin PK, Feher MD, Elkeles RS, Diabetic macrovascular disease and serum lipids: is there a connection? Diabetic Med 9:9–14, 1992
Beller GA, Gibson RS, Sensitivity, specificity and prognostic significance of noninvasive testing for occult or known coronary disease. Prog Cardiovasc Dis 29:241–270, 1987
Arstila M, Kallio V, Seppänen A, Clinical exercise testing. Standards for procedures and recommendations for the interpretation. Publications of the Social Insurance Institution, Finland 34:5–7, 1984
Huikuri HV, Ikäheimo MJ, Linnaluoto MK, Takkunen JT, Left ventricular response to isometric exercise and its value in predicting the change in ventricular function after mitral valve replacement for mitral regurgitation. Am J Cardiol 51:1110–1115, 1983
Gidez LI, Miller GJ, Burstein M, Slagle S, Eder HA, Separation and quantitation of subclasses of human plasma high density lipoproteins by a simple precipitation procedure. J Lipid Res 23:1206–1223, 1982
Friedewald WT, Levy RI, Fredricksen DS, Estimation of the concentration of low density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499–502, 1972
Kuusi T, Palosuo T, Ehnholm C, Immunonephelometric measurement of human plasma apolipoproteins A-I and A-II: an assay performed by consecutive addition of the two antisera to a single specimen. Scand J Clin Lab Invest 45:245–253, 1985
Ehnholm C, Lukka M, Kuusi T, Nikkilä E, Utermann G, Apolipoprotein E polymorphism in the Finnish population: gene frequencies and relation to lipoprotein concentrations. J Lipid Res 27:227–235, 1986
Bellet S, Roman L, The exercise test in diabetic patients as studied by radioelectrocardiography. Circulation 36:245–254, 1967
Levitas IM, Kristal JJ, Stress exercise testing of the young diabetic for the detection of unknown coronary artery disease. Israel J Med Sci 8:845–847, 1972
Storstein L, Jervell J, Response to bicycle exercise testing in long-standing juvenile diabetes. Acta Med Scand 205:227–230, 1979
Koistinen MJ, Huikuri HV, Pirttiaho H, Linnaluoto MK, Takkunen JT, Evaluation of exercise electrocardiography and thallium tomographic imaging in detecting asymptomatic coronary artery disease in diabetic subjects. Br Heart J 63:7–11, 1990
Koistinen MJ, Huikuri HV, Pirttiaho H, Linnaluoto MK, Takkunen JT, Evaluation of 24-hour ambulatory electrocardio-graphic recording in detecting asymptomatic coronary artery disease in diabetic subjects. Am J Noninvasive Cardiol 4:312–316, 1990
Kannel WB, Lipids, diabetes, and coronary heart disease: insights from the Framingham study. Am Heart J 110:1100–1107, 1985
Knuiman MW, Welborn TA, McCann VJ, Stanton KG, Constable IJ, Prevalence of diabetic complications in relation to risk factors. Diabetes 35:1332–1339, 1986
Rönnemaa T, Laakso M, Kallio V, Pyörälä K, Maarniemi J, Puukka P, Serum lipids, lipoproteins, and apolipoproteins and the excessive occurrence of coronary heart disease in non-insulin-dependent diabetic patients. Am J Epidemiol 130:632–645, 1989
Yudkin JS, Forrest RD, Jackson CA, Microalbuminuria as predictor of vascular disease in nondiabetic subjects. Islington Diabetes Survey. Lancet 8610:530–533, 1988
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Koistinen, M.J., Huikuri, H.V., Korhonen, U.R. et al. Asymptomatic coronary artery disease in diabetes: relation to common risk factors, lipoproteins, apoproteins and apo E polymorphism. Acta Diabetol 31, 210–214 (1994). https://doi.org/10.1007/BF00571953
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00571953