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0COMPARITIVE FREQUENCY OF CLINICAL-ANAMNESTIC
PARAMETERS AND ASSESSMENT OF CARBOHYDRATE METABOLISM PARAMETERS IN PATIENTS WITH CHD AND DM-2 WITH DIFFERENT LVEF CATEGORIES AT OBSERVATION STAGES
1Mukhtarova Sh.Sh., 2Trigulova R.Kh., 3Nasirova Kh.K., 4Alimova D.A., 5Akhmedova D.T.
^Tashkent Pediatric medical institute 2'4'5 Head of the Research Laboratory of Preventive Cardiology, State Institution of the Republican Specialized Scientific and Practical Medical Center of Cardiology of the Ministry of
Health of the Republic of Uzbekistan https://doi.org/10.5281/zenodo.13169111
Abstract. The article is devoted to evaluate and compare the clinical-anamnestic parameters and carbohydrate metabolism in patients diagnosed with CHD and DM2 across various categories of LVEF.
Keywords: type 2 diabetes mellitus; coronary heart disease; heart failure; cardiovascular events; ejection fraction.
Introduction. Patients with T2DM are at higher risk of death and cardiovascular outcomes than the general population. Epidemiological studies have shown that in the next 20 years the number of patients suffering from T2DM will double [4]. This group of patients faces two main problems: the prognosis of the disease worsens and the number of drugs that doctors prescribe to them increases. NGLT-2 are a class of anti-diabetic drugs that can improve the quality of life and prognosis in patients with CHF in combination with T2DM, occurring in 12-46% of cases [2]; [3], as well as in the absence of DM-2 [1]. Expected results from ongoing studies will determine whether SGLT-2 inhibitors have an impact on patient-centered endpoints, including physical activity and quality of life [5]. Thus, the interaction of IHD and T2DM is accompanied by a significant risk of CVD complications. This highlights the need to continually monitor and optimize patient treatment strategies based on their individual characteristics.
Purpose: Analysis of the comparative frequency of occurrence of clinical and anamnestic parameters and assessment of the carbohydrate profile in patients with coronary artery disease with diabetes mellitus-2 with different categories of LVEF during the observation stages.
Material and methods. The study included 130 patients with diabetes mellitus 2 (WHO, 1999) and coronary artery disease (EOC) at the age of 65.6 ± 9.7 years, the duration of diabetes mellitus 2 and coronary artery disease was 8.8 ± 5.2 and 7.5 ± 3 ,6 years respectively. Demographic parameters were analyzed: age, AMI, stroke/TIA, history of COVID, history of type 2 diabetes, AF (paroxysm), PCI, CABG, CE, history of asthma. Depending on LVEF, patients are divided into two subgroups (A 1 - EF <41-49% and B group EF>50%). Then, according to the H2FPEF scale [6], to determine the probability of HF, patients with shortness of breath and preserved EF with increased BNP (B) are divided into 2 subgroups: subgroup 2 (with a probability of HF >50%) and 3 (with a probability of HF <50%). Of the 92 parameters we analyzed, only data with statistically significant differences were selected for discussion and the full lipid spectrum, fasting and PPG, HbA1c, CRP, BNP, vitamin D, sUA, and LVEDP were determined. Also, Basic therapy:
anticoagulants, antiplatelet agents, nitrates, beta blockers, RAAS blockers, statins, empagliflozin, antihypertensive drugs. The observation period was 2 years. Static processing was carried out using the nonparametric one-factor Kruskal-Wallis analysis of variance.
Results. Assessing the clinical characteristics of those examined: AMI, AF, CABG, a history of stroke was suffered in group A versus B: 50.0% (30) - 23.2% (16) (t=27.030; P=0.000);
21.3% (13) -1.4% (1) (t=23.525; P=0.000); 8.3% (5) -10.1% (7) (t=0.504; p=0.478); 6.7% (4) - 4.28% (3) (t=0.258, p=0.612). That is, the number of patients with a history of AMI and EF in the group with moderately reduced LVEF was 2.3 and 5 times higher, respectively, than with preserved LVEF. In terms of experience with Covid during the pandemic, no intergroup differences between groups A and B are recorded - 50.0% (30) versus 55.9% (39), as well as between groups 2 and 3 - 56.5% (13) versus 55.3 % (26) (t=0.059; p=0.809). During the two-year observation period, all of the above parameters had a statistically significant decrease in their number on average p = 0.000. The only parameter is PCI, which is 1.7 times higher in group 3 (p = 0.007) versus 2, but over 2 years of follow-up with 0% of cases versus group 2 4.3%. All patients had concomitant hypertension - 100% (130), DM-2 - in 100% (130), dyslipidemia - 100% (130), 54.8% (74) were smokers, the number of patients over 60 years old was 74.6 % (97) (Table 1).
Table 1
Comparative characteristics of the frequency of occurrence of clinical and anamnestic parameters in patients with coronary artery disease with type 2 diabetes with different
categories of L VEF
Index/ Visit FV>50, n-70 V group
FV <50, n-60 A group (1) H2FPEF, P>50% (N=23) (2) H2FPEF, P<50% (N=47) (3) (P)
Age; years M (Q1; Q3) 65.87±9.03 66.5 [59.8; 71.0] 66.17±10.59 67.0 [62.0; 74.5] 64.96±10.01 66.0 [58.5; 72.5]
IHD experience; years M (Q1; Q3) 6.73±2.71 5.5 [5.0; 9.0] 8.43±3.15 7.0 [5.5; 10.0] 8.17±4.53 7.0 [5.0; 11.5] 1_20.028
SD experience; years M (Q1; Q3) 7.62±4.12 7.0 [5.0; 11.0] 9.65±4.42 10.0 [7.0; 14.0] 9.89±6.30 10.0 [5.0; 13.5] 1_20.052 1_30.071
Gender [M/F]; % (n) 45.0% (27) 60. 9% (14) 63.8% (30) 1_20.001 1_30.000
FP; % (n) 1; 2 21.7% (13) 4.3% (1) 0.0% (0) 1_20.000
3.3% (2) 0.0% (0) 2.1% (1)
X2; P 1; 2 19.804; 0.000 4.545; 0.033 0.000
Anamnesis OIM; % (n) 1; 2 50.0% (30) 21.7% (5) 23.4% (11) 1_20.000 1_30.000
1.7% (1) 0.0% (0) 0.0% (0)
X2; p 1; 2 93.444; 0.000 27.778; 0.000 30.556; 0.000
PCI; % (n) 1; 2 33,3% (20) 17,4% (4) 29,8% (14) 1 20.000 2"30.007
1.7% (1) 4.3% (1) 0.0% (0)
X2; P 1; 2 45.125; 0.000 11.842; 0.001 42.424; 0.000
KSH; % (n) 1; 2 8.3% (5) 13.0% (3) 8.5% (4)
0.0% (0) 0.0% (0) 0.0% (0)
x2; p 1; 2 9.091; 0.003 15.000; 0.000 9.302; 0.002
ONMK; % (n) 1; 2 6.7% (4) 4.3% (1) 4.3% (2)
0.0% (0) 4.3% (1) 0.0% (0) i"20.03 3
x2; p 1; 2 7.143; 0.008 0.000; 1.000 4.444; 0.035
Covid -19; % (n) 1; 2 50.0% (30) 56.5% (13) 55.3% (26)
3.3% (2) 0.0% (0) 8.5% (4)
X2; p 1; 2 inf; 0.000 3.443; 0.064 9.302; 0.002
The average intergroup values of fasting glycemia for patients in the analyzed groups with EF>50 and EF 41-49% at baseline and at follow-up did not demonstrate statistically significant differences: P was not lower than 0;606. The average intergroup parameters of postprandial glycemia in groups A and B differed t=4.697; p=0.030) in the initial state and turned out to be statistically significant. However, at the follow-up stages there was a downward trend (t=2.767; p=0.096); but no intergroup differences were noted. At the same time, we can state with greater confidence; that the difference obtained is due to group 3; those. with a subgroup with a low probability of HF.
Analysis of glycated hemoglobin showed a statistically insignificant intergroup difference (t=0.317; p=0.186); and at follow-up visits: P was not lower than 0;873. Similar statistically insignificant intergroup changes were noted when considering the results of calculating the degree of insulin resistance HOMA-IR (t=1.322; p=0.250) and the functional reserve of beta cells HOMA-B (t=0.290; p=0.590). At the stages of observation in A HOMA-IR (t=1.573; p=0.210); HOMA-B (t=0.515; p=0.473) versus group B (t=0.400; p=0.527) and (t=0.072; p=0.788), respectively (Table 2).
Table 2
Indicators of carbohydrate metabolism in patients with coronary artery disease with diabetes mellitus-2 with different categories of LVEF at the stages of observation. (M±d; M (Q1-Q3)
FV>50; n-70 V group
Index/ Visit FV <50; n-60 A group (1) H2FPEF; R>50% (N=23) (2) H2FPEF; R<50% (N=47) (3) (R)
Fasting glycemia (mmol/l) / 1; 2 M (Q1-Q3) 7.84±3.08 6.4 [5.6; 9.7] 8.24±3.12 7.5 [6.1; 9.4] 8. 09±2.89 6.9 [6.0; 9.6]
7.51±2.45 6.5 [5.6; 9.2] 7.67±2, 7.4 [5.8; 9.6] 7.83±2.98 7.0 [5.8; 8.4]
(R) 1 h 2 visit 0.694 0.809 0.604
Postprandial 11.18±4.62 12.70±4.75 12.77±4.43 1 30.02
glycemia 9.0 [7.4; 14.9] 12.6 [9.1; 14.8] 11.5 [9.3; 16.4]
(mmol/l)/ 1; 11.22±4.81 12.15±3.71 12.22±4.37
2 9.4 [7.3; 13.5] 12.3 [8.6; 15.3] 12.1 [8.4; 14.8]
M (Q1-Q3)
(R) 1 h 2 0.992 0.835 0.482
visit
HbA1c (%) / 7.75±2.24 7.62±1.71 7.94±1.80
1; 2 6.8 [6.0; 8.8] 7.2 [6.2; 8.8] 7.6 [6.5; 9.2]
M (Q1-Q3) 7.58±2.00 7.79±1.35 8.01±2.17
6.7 [6.0; 8.7] 8.0 [6.4; 8.9] 7.4 [6.1; 9.4]
(R) 1 h 2 0.754 0.598 0.776
visit
Index 5.6±3.2 6.9±3.53 6.8±5.27
HOMA IR / 5.0 [3.2; 6.8] 5.8 [4.4; 9.6] 5.2 [3.3; 8.4]
1; 2 5.2±3.0 5.7±2.83 5.6±3.79
M (Q1-Q3) 4.5 [2.9; 7.1] 5.2 [3.8; 6.6] 4.4 [3.0; 7.7]
(R) 1 h 2 0.427 0.995 0.480
visit
Index 42.0±23.3 48.9±28.4 47.9±37.5
HOMA-B / 39.8 [24.2; 58.7] 40.7 [28.3; 69.7] 35.5 [20.7; 60.2]
1; 2 39.9±20.0 42.1±17.1 43.4±31.2
M (Q1-Q3) 38.6 [25.2; 54.6] 40.4 [26.2; 52.5] 29.9 [20.5; 61.6]
(R) 1 h 2 0.725 0.575 0.647
visit
A significant statistical difference is recorded between groups with EF with moderately reduced (Group A) and preserved EF; but in the absence of differences between the HF group P>50% (B group) and P<50% (C group) before (t=0.423; P=0.516) and at the follow-up stage (t=0.448; P=0.504). In the group with EF >50%, both subgroups showed a trend towards a decrease in BNP; not having statistical significance. Assessing the clinical characteristics of those examined: AMI; FP; KS; A history of stroke occurred in group A versus B: 50.0% (30) - 23.2% (16) (t=27.030; P=0.000); 21.3% (13) -1.4% (1) (t=23.525; P=0.000); 8.3% (5) -10.1% (7) (t=0.504; p=0.478); 6.7% (4) - 4.28% (3) (t=0.258; p=0.612). Those.; the number of patients with a history of AMI and EF in the group with moderately reduced LVEF was 2.3 and 5 times greater, respectively; than with preserved LVEF.
In terms of experience with Covid during the pandemic, no intergroup differences between groups A and B were recorded - 50.0% (30) versus 55.9% (39); as well as between groups 2 and 3 - 56.5% (13) versus 55.3% (26) (t=0.059; p=0.809).
During the two-year observation period, all of the above parameters had a statistically significant decrease in their number on average p = 0.000. The only parameter is PCI, which is 1.7 times higher in group 3 (p = 0.007) versus 2; but over 2 years of observation with 0% of cases versus group 2 4;3%. The average intergroup values of fasting glycemia for patients in the analyzed groups with EF>50 and EF 41-49% at baseline and at follow-up did not demonstrate statistically significant differences: P was no less than 0.606. The average intergroup HbA1c
parameters in groups A and B differed t=4.697; p=0.030) in the initial state and turned out to be statistically significant. However, at the follow-up stages there was a downward trend (t=2.767; p=0.096); but no intergroup differences were noted. At the same time, we can state with greater confidence; that the difference obtained is due to group 3; those. with a subgroup of low probability of HF. Analysis of HbA1c showed a statistically insignificant between-group difference (t=0.317; p=0.186); and at follow-up visits: P was not lower than 0.873. Similar statistically insignificant intergroup changes were noted when considering the results of calculating the degree of insulin resistance HOMA-IR (t=1.322; p=0.250) and the functional reserve of beta cells HOMA-B (t=0.290; p=0.590). At the stages of observation in A HOMA-IR (t=1.573; p=0.210); HOMA-B (t=0.515; p=0.473) versus group B (t=0.400; p=0.527) and (t=0.072; p=0.788), respectively.
Conclusion. Analysis of two-year follow-up showed a decrease in the incidence of AMI; FP; KS; History of stroke after basic therapy with the addition of empagliflozin (average p=0.000). The only parameter is PCI, the incidence of which is 1.7 times higher in group 3 (p = 0.007) versus 2; but over 2 years of observation with 0% of cases versus group 2 4.3%. Differences in the initial state of groups A and B in the HbA1c parameter were revealed (t=4.697; p=0.030). At the stages of observation, a tendency to decrease was noted (t=2.767; p=0.096); but no intergroup differences were noted due to a statistically insignificant increase in HbA1c levels in group 3. Similar insignificant intergroup changes were noted when analyzing the degree of insulin resistance HOMA-IR and HOMA-B (t=0.290; p=0.590).
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