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REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
62
VOLUME 8 NUMBER 2 • JUNE 2011
Prevalence of cardiovascular disease and risk biomarkers in
patients with unknown type 2 diabetes visiting cardiology
specialists: results from the DIASPORA study
Thomas Schöndorf, Georg Lübben, Efstrathios Karagiannis, Erland Erdmann,
Thomas Forst, Andreas Pfützner
Abstract
B
ackground:
Patients with diabetes mellitus and IGT
have a high risk for cardiovascular events. It is tempting
to speculate that these patients are often first seen by
cardiologists.
Design:
This cross-sectional study investigates the diabetes
prevalence in cardiology care units and the correlated
metabolic conditions as assessed by several circulating
biomarkers.
Methods:
Patients aged 55 or older with suspected or overt
coronary heart disease were eligible for trial participation.
Fasting blood samples were drawn from patients to
determine HOMA score, glycaemic and lipid profile, and
several risk biomarkers. An OGTT was performed in patients
without known diabetes.
Results:
We enrolled 530 patients (181male, 349 female, mean
age, 68
±
7 years) in this study from 22 German cardiology
centres; 156 patients (29. 4%) had known diabetes and OGTT
revealed that 184 patients (34.7%) had no diabetes, 106
patients (20. 0%) had IGT or IFG and 84 patients (15. 9%) were
newly diagnosed with diabetes. Increased cardiovascular
risk as reflected by increased hsCRP, ICAM and MMP-9 values
was observed in diabetes patients. A higher cardiovascular
biomarker risk profile was seen in the IGT/IFG cohort.
Conclusions:
This study confirms the observation that one-
third of patients in a cardiology care unit suffer from impaired
glucose regulation. Furthermore,the cardiology patients with
previously unknown glucose homeostasis abnormalities had
a higher prevalence of macrovacular disease and an impaired
biomarker risk profile. This study underlines the importance
of joint treatment efforts by cardiologists in concert with
diabetologists for treatment of this patient group at high
risk for cardiovascular events.
Keywords:
cardiodiabetes, cardiovascular risk, biomarker profile,
angiodiabetes
Introduction
Cardiovascular diseases (CVD), e.g. coronary heart disease (CHD)
such as myocardial infarction, are the major complications in
patients with type 2 diabetes (T2D) and are the major cause of
morbidity and mortality in this population. People with diabetes
suffer from a two- to four-fold increased risk of incident CHD or
fatal CVD compared with patients without diabetes. Accordingly,
CVD are the major contributor to CVD-related costs in patients
with diabetes. Early detection of diabetes is therefore considered
a cost-saving approach, together with the possibility for secondary
prevention and patient empowerment after diagnosis.
1
The
relationship of CVD and metabolic imbalance lies in the association
of metabolic (glucose, lipid) disorders with changes of vascular
reactivity or elasticity, defined as endothelial dysfunction (ED). ED is
characterised by a reduction of the bioavailability of vasodilatators,
in particular, nitric oxide, whereas endothelium-derived contracting
factors are increased. This imbalance leads to an impairment of
endothelium-dependent vasodilatation. If ED persists over an
extended period of time, reactive thickening of smooth muscle
cells on the basis of low-grade inflammation of the arterial wall
may follow. This leads to the first stages of atherosclerotic changes
which can result in macrovascular complications such as CHD.
This epidemiological study aims to assess the prevalence of
abnormal glucose metabolism, such as impaired glucose tolerance
(IGT), impaired fasting glucose (IFG), and known and newly
diagnosed overt diabetes mellitus in patients with suspected or
established CHD. It therefore contributes to answering the question
of whether screening for diabetes and IGT is reasonable in patients
with CHD.
Methods
The study was designed as a cross-sectional epidemiological study
in cardiology centres and practices throughout Germany. The trial
was approved by an institutional review board and conducted
following the regulations of good clinical practice. Prior to any
study procedure, a signed informed consent was obtained from
each patient.
Correspondence to: Dr Thomas Schöndorf
Institute for Clinical Research and Development, Mainz, Germany
University of Cologne Medical Center, Cologne, Germany
Department of Applied Natural Sciences, University of Applied Science,
Rheinbach, Germany
e-mail: thomass@ikfe.de
Dr Georg Lübben, Dr Efstrathios Karagiannis
Takeda Pharma, Aachen, Germany
Dr Erland Erdmann
University of Cologne Medical Center, Cologne, Germany
Dr Thomas Forst
Institute for Clinical Research and Development, Mainz, Germany
Dr Andreas Pfützner
Institute for Clinical Research and Development, Mainz, Germany
Department of Applied Natural Sciences, University of Applied Science,
Rheinbach, Germany
S Afr J Diabetes Vasc Dis
2011;
8
: 62–66.
