SA JOURNAL OF DIABETES & VASCULAR DISEASE RESEARCH ARTICLE VOLUME 19 NUMBER 2 • November 2022 27 reports 23.5%.6,9 The study done by Jeong et al. reports on a high percentage of diabetics in Asia, up to 39%.16 The high percentage of diabetics in our study can be explained by the fact that DM has been reaching epidemic proportions in the general population over the last two decades, and especially in the group of patients with atherosclerotic disease. Our study shows that pre-operative factors believed to increase the risk of death and stroke in diabetics include higher low-density lipoprotein values, coronary artery disease and peripheral arterial disease. A prompt diagnosis of these co-morbidities and the use of statins should reduce mortality and stroke rates after CEA. Dorigo and co-workers state that patients with diabetes were predominantly women, who suffered from coronary artery disease, peripheral arterial disease and hyperlipidaemia.6 Other authors claim that pre-CEA diagnosed risk factors such as atherosclerosis and diabetes had an effect on 30-day mortality rate and stroke, but they did not record a significant influence from dyslipidaemia.17 Our research, however, has identified most frequent postoperative complications, such as post-operative MI, coronary insufficiency, TIA, CVI, respiratory insufficiency, post-operative bleeding and wound infection. All these complications were significantly more prevalent in patients with DM. Post-operative TIA was present in 0.9% of patients without DM and in 3.6% of patients with DM (p = 0.009), while postoperative CVI was 1.3 versus 3.2%, respectively (p = 0.072). Patients with DM suffer significantly more often from early post-operative TIA and CVI. The greater risk of cerebrovascular infarction in patients with DM was reported in the recent review by Hussain et al., wherein they determined that DM was associated with a 1.5-times greater risk of stroke after CEA.18 Contrary to these statements, Ballota et al. suggest that there is no important difference in the frequency of these post-operative complications between diabetics and non-diabetics.10 Post-operative cardiological complications, including MI, occurred in 1.1% of patients without DM and in 3.6% of patients with DM (p = 0.039). However, that can be explained by the fact that our study pool consisted of a group of diabetics whose pre-operative cardiological complications were generally more prevalent. Altinbas and co-workers suggest no significant difference in post-operative cardiac events, and noted that after CEA a consequent coronary insufficiency occurred in 2.3% of cases, with no difference observed between the groups concerned.19 Ombrellaro et al. recently observed in postCEA patients undesirable cardiac events such as MI and CHF in 14.3% of patients with diabetes and in 16% of the non-diabetic group. The difference was not statistically significant.20 The frequency of haematoma of the operated wound occurred in 2.4% of non-DM patients and in 3.6% of DM patients, while wound infection was present in only patients with DM (1.8%). Zhao et al. stated that the incidence of haematoma was relatively high in diabetics, the cause being pre-operative high doses of heparin (1 mg/kg), as well as double antiaggregation therapy.17 The same authors specify that diabetes may increase the possibility of wound and systemic infection, and that preoperative HbA1c levels should be about 7% to reduce possible infections.17 Post-operatively, 50% carotid restenosis in the course of one year was not significant; it occurred in 2.2% of non-DM patients and in 1.8% of DM patients (χ2 = 0.124; p = 0.724). Other investigations produced similar results.19 Total post-operative mortality (neurological and cardiological) was present in 0.9% of non-diabetics and in 2.5% of diabetics (p = 0.113). Ahari et al. report in their study that diabetics had higher 30-day mortality rates (3.2 vs 1.4%; p = 0.02).5 Total post-operative complications were observed in 8.5% of non-diabetics and in 18.3% of DM patients (p < 0.001). DM patients were at more than two times greater risk of suffering from post-operative complications. Dorigo et al. found that the risk of post-operative complications was twice as high in patients suffering from DM.6 The study by Jeong et al. concluded that DM patients were not at a greater risk of 30-day morbidity and mortality after CEA than those without DM.16 Our patients on oral antidiabetics suffered considerably more often from post-operative complications than those on insulin (25.4 vs 8.2%; p < 0.001). In the study by Axelrod et al. there was a somewhat higher percentage of post-operative complications in the diabetics, although without a significant difference between the patients on insulin and those on oral antidiabetics.21 Dimic et al. have shown the cumulative rate of TIA/cerebrovascular infarction (p = 0.02) to be greater in insulin-dependent diabetics (IDDM) than in those who are insulin-independent (IIDM).22 Similarly, Bennett et al. stated that insulin-necessitated DM is one of the independent predictors of high morbidity and mortality rates among the patients who have undergone CEA.23 However, Dorigo and co-workers discovered that patients with diabetes were at greater risk of death, but with no difference between the patients with insulin-controlled diabetes and those on oral medication.6 Parlani and colleagues reported that patients with IDDM had higher rates of cerebrovascular infarction and death (6.5 vs 1.7%; p = 0.02) than non-diabetics.7 CARVETREND 6,25, 12,5, 25 mg. Each tablet contains 6,25, 12,5, 25 mg carvedilol respectively. S3 A37/7.1.3/0276, 0277, 0278. NAM NS2 08/7.1.3/0105, 0104, 0103. BOT S2 BOT1101790, 1791, 1792. For full prescribing information, refer to the professional information approved by SAHPRA, 13 December 2019. 1) Panagiotis C Stafylas, Pantelis A Sarafidis. Carvedilol in hypertension treatment. Vascular Health and Risk Management 2008;4(1):23-30. CDA891/09/2022. www.pharmadynamics.co.za CUSTOMER CARE LINE +27 21 707 7000 RESTORE cardiac function ß C A R V E D I L O L 6,25 mg 12,5 mg 25 mg CARVEDILOL: • is indicated twice daily for mild to moderate stable symptomatic congestive heart failure • is indicated once daily for essential mild to moderate hypertension • has no significant metabolic eects1
RkJQdWJsaXNoZXIy NDIzNzc=