Diabetic coronary artery disease and risk of myocardial infarction

The raised incidence of myocardial infarction and sudden death in diabetics was explained over 20 years ago by the increase in prevalence and severity of coronary atherosclerosis. Coronary :angiographies of 820 consecutive pa tients admitted to hospital for coronary artery disease were analysed. One hundred and fifteen of these patients (14%) were diabetic. In 77.4% of diabetics and 72.6% of non-diabetics, coronary angiography show ed coronary lesions which were usually distal and three vessel in diabetics . When the three coronary arteries were analysed globally, the percentage o f patients with at least one mild stenosis was much higher in diabetics tha n in non-diabetics (50.6% vs 30.3% respectively, p < 0.001), but-there was no statistical difference in the number of severe stenoses or occlusions. The increase in mild stenosis:in the diabetic population could indicate an anatomical predisposition to future rupture of-a plaque. This result could explain the increased frequency of myocardial infarction and sudden death i n diabetes, not necessarily preceded clinically by angina pectoris.