Determinants of the severity and extent of coronary artery disease in patients with type-2 diabetes and in nondiabetic subjects

Background factors predicting the anatomic distribution and the severity an d extent of coronary atherosclerosis in patients with clinically manifest c oronary artery disease (CAD) for type-2 diabetic patients could be differen t than those for nondiabetic patients. Objective To study the determinants of severity and extent of CAD in consec utive patients with type 2 diabetes mellitus, compared with those for match ed nondiabetic patients, undergoing clinically indicated coronary angiograp hy. Methods Coronary angiograms of 48 men and seven women with type-2 diabetes and an equal number of nondiabetic subjects were analyzed quantitatively. S cores reflecting severity and extent of CAD were compared with potential ri sk factors using univariate correlation analyses and multivariate regressio n models. Results For the diabetics, a global coronary atheroma burden index was inde pendently and directly related to age (P = 0.022) and to level of intermedi ate-density lipoprotein cholesterol (P = 0.055), and inversely to level of particles of a subtype of high-density lipoprotein (P = 0.022), Several ang iographic indexes were related to the duration of diabetes and control of g lycemia. For the nondiabetic group, global atheroma burden was independentl y related to age (P = 0.028), a history of hypertension (P = 0.028), and co ncentration of low-density lipoprotein (P = 0.013), and inversely to level of apolipoprotein A-I (P = 0.008). The duration of coronary disease and a h istory of smoking were also predictive of severe coronary atherosclerosis a mong nondiabetic patients, Conclusions Classical risk factors are strong predictors of the severity an d extent of coronary atherosclerosis in nondiabetic patients, but the most important determinants for type-2 diabetic patients are levels of triglycer ide-rich lipoproteins and apolipoprotein A-I-containing particles of high-d ensity lipoprotein, and factors directly related to diabetes. Coron Artery Dis 12:99-106 (C) 2001 Lippincott Williams & Wilkins.