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ORIGINAL ARTICLE
Year : 2016  |  Volume : 19  |  Issue : 2  |  Page : 59-62

A comparison of carotid intimal thickness and other risk factors in patients with prediabetes and normoglycemic subjects in the Eastern India


1 Department of Medicine, College of Medicine and JNM Hospital, Kalyani, Nadia, India
2 Department of Medicine, ESIC Hospital, Joka, West Bengal, India
3 Department of Medicine, R. G. Kar Medical College, Kolkata, West Bengal, India

Date of Web Publication12-Jul-2016

Correspondence Address:
Somak Kumar Das
A/14, 2nd Floor, Katjunagar, Jadavpur, Kolkata - 700 032, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1118-8561.186040

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  Abstract 

Introduction: Prediabetes is a precursor to diabetes; it is an intermediary state between normoglycemia and hyperglycemia. This metabolic state keeps company with major risk factors for atherovascular disease. The risk of coronary artery disease (CAD), including myocardial infarction, is higher in prediabetes patients compared to normal population. Aim: The aim of this study is to assess the prevalence of prediabetes in the patients with CAD and to compare the glycemic status, carotid intimal thickness (CIMT) and other risk factors in the prediabetes patients and normoglycemic subjects. Materials and Methods: One-hundred and fifty CAD patients and 80 control subjects who were age and sex matched were studied. Fasting blood glucose, a 2 h glucose tolerance test and CIMT were compared in both groups. Results: Mean age in the control group was 59.93 ± 10.84 years whereas it was 61.0 ± 11.02 years in the CAD. The mean CIMT was more and statistically significant in the case group. Impaired fasting glucose (IFG) was found in 30 (20%) cases and impaired glucose tolerance (IGT) was found in 45 (30%) cases, and both IFG and IGT were found in 12 (8%) cases. The prevalence of prediabetes in this study was 58%. Nondiabetic CAD patients had statistically higher fasting glucose level, 2-h oral glucose tolerance test values, total cholesterol and very low density lipoprotein levels than control patients. Conclusion: These findings stress the need for early screening and management of prediabetes preventing further progression to diabetes and CAD, even in rural patients.

Keywords: Carotid intimal thickness, coronary artery disease, prediabetes


How to cite this article:
Das SK, Ghosh S, Nath T, Jana CK. A comparison of carotid intimal thickness and other risk factors in patients with prediabetes and normoglycemic subjects in the Eastern India. Sahel Med J 2016;19:59-62

How to cite this URL:
Das SK, Ghosh S, Nath T, Jana CK. A comparison of carotid intimal thickness and other risk factors in patients with prediabetes and normoglycemic subjects in the Eastern India. Sahel Med J [serial online] 2016 [cited 2024 Mar 29];19:59-62. Available from: https://www.smjonline.org/text.asp?2016/19/2/59/186040


  Introduction Top


Coronary artery disease (CAD) is the most common form of heart disease worldwide.[1] the modifiable risk factors for CAD are hypertension, diabetes mellitus, smoking, obesity, and hyperlipidemia. Out of all the risk factors, diabetes mellitus is one of the most important risk factor for CAD. Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are precursor to diabetes; it is an intermediary state between normoglycemia and hyperglycemia. This metabolic state keeps company with major risk factors for atherovascular disease such as metabolic syndrome and insulin resistance. The risk of coronary heart disease begins to increase at least 15 years before the onset of hyperglycemia in a diabetic. The risk of coronary heart disease is higher in IFG and IGT patients compared to the normal population; sometimes the myocardial infarction may be the initial presentation of IGT or overt diabetes.[2] Carotid intimal thickness (CIMT) is also a marker of atherosclerotic vascular disease. So, this study is planned to assess the prevalence of IFG and IGT state in the patients of nondiabetic CAD in a part of rural West Bengal, thereby permitting early initiation of appropriate preventable measures.

Aim and objective

The objectives of our present study was:

  1. Estimation of prevalence of prediabetes in nondiabetic CAD patients,
  2. Comparison of CIMT, dyslipidemia, and other risk factors between the patients with nondiabetic CAD and normoglycemia.



  Materials and Methods Top


Study design

The study was conducted in College of Medicine and JNM Hospital, West Bengal University of Health Sciences, Kalyani and College of Medicine and Sagore Dutta Hospital, Kamarhati, Sodepur – Panihati, West Bengal from September 2013 to March 2014. Both of these tertiary hospitals were situated in the rural area of West Bengal and served the rural patients in majority. Before conduction of the study, we took the clearance from the Institutional Ethics Committee of the institutions. In this comparative study, we included 150 nondiabetic CAD patients and 80 subjects of control matched by age, gender, and risk factors. We included consecutive adult patients (>6 years of age) of both sexes attending the out-patient department (OPD) and/or in-door of the Department of Medicine. CAD patients were diagnosed and included in the study on the basis of specific and standard electrocardiogram (ECG) changes – ST segment depression, and/or T-wave inversion in resting ECG and/or by standard “stress test,” echocardiography (both two-dimensional [2D] and color Doppler mode) finding – Regional wall motion abnormality and wall motion score index, and/or coronary angiography. Consecutive adult patients (>6 years of age) of both sexes attending the OPD and/or in-door of the Department of Medicine who did not have any history or diagnosis of CAD by the above mentioned investigations, were considered as control group. Among all subjects, only four patients gave consent to undergo coronary angiography and of them, three patients had significant double vessel disease and one had triple vessel disease. We excluded diabetic patients; diabetes being diagnosed according to the World Health Organization criteria.

Parameter studied

Examination during OPD/admission included medical history, clinical examination, and routine blood chemistry. Fasting blood sugar, 2-h oral glucose tolerance test (OGTT), lipid profile, ECG, 2D echocardiography, and carotid Doppler study. Venous blood samples were taken after 12 h of fasting. Blood sugar levels (reference range: 60–100 mg/dl) were estimated by the glucose oxidase-peroxidase method using the glucose analyzer. B-mode ultrasound scan of common carotid artery (CCA) was done to assess intimal thickness (IMT). IMT measurements were obtained with the patient lying in the supine position and with the neck rotated to the opposite side of examination. CCA images were obtained to measure IMT by using three different angle views for each vessel. Results were analyzed using suitable statistical software, SPSS version 20 (IBM, NY, USA). Statistical significance of parameters between groups was evaluated using Student's t-test. Statistical significance was inferred at P ≤ 0.05.


  Results Top


In the present study, 123 (82%) were males and 27 (18%) were females among 150 cases and 59 (73.75%) males and 21 (26.25%) females among 80 controls. The maximum number of cases was in age group of 54–57 years. Mean age in the control group was 59.93 ± standard deviation (SD) 10.84 year whereas in the case it was 61 ± SD 11.02 year (P = 0.64).

In this study, IFG was found in 30 (20%) cases and IGT was found in 45 (30%) cases, and both IFG and IGT were found in 12 (8%) cases. In total, the abnormal glucose regulation was found in 58% cases. In control group, there was only 6% subject to have prediabetes. The mean CIMT in case group was 0.703 ± 0.105 and that in control was 0.611 ± 0.130 (P = 0.001).

Distribution of selected clinical and metabolic risk factors in study groups is shown in [Table 1]. Nondiabetic CAD patients had statistically higher fasting glucose level, 2-h OGTT values, total cholesterol and very low density lipoprotein levels than control patients.
Table 1: Distribution of selected clinical and metabolic risk factors in study groups

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  Discussion Top


CAD is still the leading cause of mortality in many countries.[1] The prevalence of its risk factors, especially obesity and diabetes, are increasing toward an alarming level. A prediabetic state, which is defined as the time period before the development of symptomatic diabetes, is a silent cardiovascular risk factor.[1],[2],[3] CIMT is also considered as a surrogate marker of cardiovascular disease. It is an independent risk factor and a tool for early detection of the atherosclerosis.[4]

Several previous cross-sectional studies have enquired the association between fasting glucose and CAD. The largest of the population-based studies revealed that in 2184 nondiabetic participants, FPG was associated with the prevalent CAD in men but not in women. The two largest studies reported to date, the Coronary Artery Risk Development in Young Adults Study (n = 3043) and the Framingham Offspring Study (n = 3054), each concluded no significant independent relationships between the prediabetes and CAD.[5],[6] Few studies to date have assessed the associations between the prediabetes and CIMT.[7] In a cross-sectional study of the Italian adults, no independent association was shown between the prediabetes with CIMT.

The Indo Heart Survey was performed on latent abnormal glucose regulation in the patients with CAD without diabetes across India. Of the 350 patients studied, 176 (50.28%) had impaired glucose regulation (IFG – 28 [8%]; IGT – 148 [42.28%]), and 75 (21.42%) had newly detected diabetes.[8] In all 251 (71.7%) patients with CAD had previously undetected abnormal glucose regulation. In China Heart Survey, among 773 acutely admitted CAD patients, researchers found IGT in 267 (34.5%) patients, and IFG in 35 (4.5%) patients. In the present study, we found almost similar pattern in prevalence of IFG, IGT, and prediabetes. We also found statistically significant higher CIMT in nondiabetic CAD patients having prediabetes. This result also supports the previous studies.

Abnormal glucose regulation is common in the patients admitted to hospital with CAD and is undiagnosed in the majority of these patients. Our data showed that IGT and to a lesser extent IFG were associated with impaired cardiovascular conditions. These findings, along with the statistically higher CIMT, provide further evidence for increased cardiovascular risk associated with prediabetes. As abnormal glucose regulation is a strong risk factor for cardiovascular events, earlier detection of it will allow clinicians to institute more rigorous control of patients with hyperglycemia and therefore improve outcomes. In particular, early identification and treatment of individuals with impaired glucose regulation will reduce the risks of progression to abnormal glucose regulation and associated complications. Prevalence of prediabetes, CAD, and CIMT were studied previously in the urban population. Due to different life style, rural people showed less cardiovascular risk in terms of prediabetes, diabetes, dyslipidemia, and CIMT. Our study showed that the rural people are also under the risk of CAD.


  Conclusion Top


Prediabetes is common in nondiabetic Indian population with CAD. Contrary to earlier reports of rural people are also at the risk of prediabetes and CAD with the adoption of urban life style. Whatever the preventive measures are contemplated rural population should be considered also.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kahn R, Robertson RM, Smith R, Eddy D. The impact of prevention on reducing the burden of cardiovascular disease. Circulation 2008;118:576-85.  Back to cited text no. 1
    
2.
Jarauta E, Mateo-Gallego R, Bea A, Burillo E, Calmarza P, Civeira F. Carotid intima-media thickness in subjects with no cardiovascular risk factors. Rev Esp Cardiol 2010;63:97-102.  Back to cited text no. 2
    
3.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33 Suppl 1:S62-9.  Back to cited text no. 3
    
4.
de Groot E, Hovingh GK, Wiegman A, Duriez P, Smit AJ, Fruchart JC, et al . Measurement of arterial wall thickness as a surrogate marker for atherosclerosis. Circulation 2004;109 23 Suppl 1:III33-8.  Back to cited text no. 4
    
5.
Carson AP, Lewis CE, Jacobs DR Jr, Peralta CA, Steffen LM, Bower JK, et al . Evaluating the Framingham hypertension risk prediction model in young adults: The Coronary Artery Risk Development in Young Adults (CARDIA) study. Hypertension 2013;62:1015-20.  Back to cited text no. 5
    
6.
D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al . General cardiovascular risk profile for use in primary care: The Framingham heart study. Circulation 2008;117:743-53.  Back to cited text no. 6
    
7.
Ford ES, Zhao G, Li C. Pre-diabetes and the risk for cardiovascular disease: A systematic review of the evidence. J Am Coll Cardiol 2010;55:1310-7.  Back to cited text no. 7
    
8.
Mardikar M, Deo D, Deshpande NV, Khanolkar U, Mathew R, Khan A, et al . Indo heart survey on latent abnormal glucose regulation in patients with coronary artery disease without diabetes across India. Indian Heart J 2008;60:113-8.  Back to cited text no. 8
    



 
 
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