New diagnostic criteria for diabetes and coronary artery disease: Insightsfrom an angiographic study

OBJECTIVE The goal of this research was to study coronary atherosclerosis i n patients with type 2 diabetes compared with patients without diabetes acc ording to the new definition of diabetes advocated by the American Diabetes Association in 1997. BACKGROUND Patients with diabetes (fasting plasma glucose above 7.0 mM/L) h ave a higher risk of cardiovascular death. The correlation with the pattern and severity of their coronary atherosclerosis, especially in the new pati ents with "mild" diabetes (7.0 mM/L less than or equal to fasting plasma gl ucose < 7.8 mM/L), remains unclear. METHODS A cohort of 466 patients undergoing coronary angiography but free o f any previous infarction, coronary intervention and insulin therapy were p rospectively recruited. Ninety-three had diabetes (fasting plasma glucose > 7.0 mM/L or hypoglycemic oral treatment). Five angiographic indexes were c alculated to describe severity and extent of coronary atherosclerosis. RESULTS Overall, patients with diabetes had more diffuse coronary atheroscl erosis, a greater prevalence of mild, moderate and severe stenoses and a tw o-fold higher occlusion rate than patients without diabetes, even after adj ustment for age, gender, body mass index, hypertension, lipid parameters, s moking, family history of cardiovascular events and ischemic symptoms. Pati ents with "mild diabetes" had a coronary atherosclerosis pattern more simil ar to patients with normal fasting plasma glucose than to patients formerly defined as diabetic according to the World Health Organization criteria, e xcept that they had a higher prevalence of <50% stenoses. CONCLUSIONS In patients with type 2 diabetes, those with 7.0 mM/L <less tha n or equal to> fasting plasma glucose < 7.7 mM/L have a slightly greater pr evalence of mildly severe lesions that may partly explain their higher card iovascular event rate. (J Am Coll Cardiol 2001;37:1543-50) (C) 2001 by the American College of Cardiology.