Diabetes is a significant
risk factor for ACS and adds to the overall burden of cardiovascular disease. This study was done to compare clinical and demographic
features and signs and symptoms of ACS, diagnosed by history, ECG, Cardiac enzymes
markers among Type 2 diabetic patients and non-diabetic patients. This cross-sectional
study was conducted at jubilee memorial hospital and Dr SM CSI medical college,
trivandum. The study population included 93 patients with
DM and 107 subjects without DM as controls from the department of General medicine.
Detailed history, anthropometry and clinical examination were recorded from all
patients and Profile of ACS was compared between the two groups. Out of 93
diabetic patients, 67.7% (n63) had STEMI while compared to nondiabetic (51.4%, n55)
patients and 32.2% (n30) had NSTEMI/UA compared to non-diabetic (48.6%, n52) patients.
There is statistically significant association between STEMI and diabetes mellitus.
(P value is 0.019). In our study smoking increased the mortality in diabetic patients
(p value .013). There was no significant association between dyslipidemia and diabetes
mellitus (p value .077) even though higher proportion of patients with diabetes
mellitus had dyslipidemia. It was concluded that incidence of STEMI is significantly
more in diabetic patients compared to non-diabetic patient in our study. High prevalence
of diabetes mellitus among ACS patients were observed and this study also shown
that smoking increased the mortality in diabetic patients. Dyslipidemia in diabetic
patient is more when compared to non-diabetic patients even though statistically
not significant in this study group.
Keywords: STEMI, NSTEMI,
ACS, DM, ECG.
Abildstrom, S.Z., Rasmussen, S., Rosen, M.,
& Madsen, M. (2003). Trends in incidence and case fatality rates of acute myocardial
infarction in Denmark and Sweden. Heart,89(5),507-11.
Adler, A. I., Stratton, I.M., Neil, H.A.,
Yudkin, J.S., Matthews, D.R., Cull, C. A .,…. Holman, R. R. (2000). Association
of systolic blood pressure with macrovascular and microvascular complications of
type 2 diabetes (UKPDS 36): prospective observational study. BMJ, 321
Dauerman, H.L., Lessard, D., Yarzebski, J.,
Furman, M.I., Gore, J. M., & Goldberg, R. J. (2000). Ten- year trends in the
incidence, treatment, and outcome of Q-wave myocardial infarction. Am J Cardiol ,86(7),730-5.
Fergus, S. R. F. (2004). Presentation, management,
and outcomes of diabetic patients compared to non-diabetic patients admitted for
acute coronary syndromes. Heart, 1501-1502
Garcia, M.J., McNamara, P.M., Gordon, T., &
Kannel, W. B. (1974). Morbidity and mortality in diabetics in the Framingham population.
Sixteen-year follow-up study. Diabetes,
Geiss, L.S., Herman, W.M., & Smith, P.
J. (1995). Mortality in non-insulin- dependent diabetes. In: National Diabetes Data
Group, editor. Diabetes in America, 2nd ed. Bethesda, MD: NIH & NIDDK. National Diabetes Information Clearing House,
Haffner, S. M., Lehto, S., Ronnemaa, T., Pyorala,
K., & Laakso, M. (1998). Mortality from coronary heart disease in subjects with
type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.
N Engl J Med, 339, 229-34.
Hellermann, J.P., Reeder, G.S., Jacobsen, S.J.,
Weston, S.A., Killian, J. M., & Roger, V. L. (2002). Longitudinal trends in
the severity of acute myocardial infarction: a population study in Olmsted County,
Minnesota. Am J Epidemiol,156(3),246-53.
Hu, F.B. (2011). Globalization of Diabetes:
The role of diet, lifestyle, and genes. Diabetes
W.B., & McGee, D.L. (1979). Diabetes and cardiovascular disease. The Framingham
studies. JAMA ,241,2035-8.
P. (2005). Learning from large cardiovascular clinical trials: classical cardiovascular
risk factors. Diabetes Res Clin Pract,
68 (1), S43-7.
. King, H.,
Aubert, R. E., & Herman, W. H. (1998). Global burden of diabetes, 1995–2025:
prevalence, numerical estimates, and projections. Diabetes Care, 21, 1414–1431.
M. (1997). Dyslipidemia, morbidity, and mortality in non- insulin-dependent diabetes
mellitus. Lipoproteins and coronary heart disease in non-insulin-dependent diabetes
mellitus. J Diabetes Complications, 11 ,137-41.
. Lehto, S.,
Ronnemaa, T., Haffner, S.M., Pyorala, K., Kallio, V., &Laakso, M. (1997). Dyslipidemia
and hyperglycemia predict coronary heart disease events in middle-aged patients
with NIDDM. Diabetes, 46 ,1354-9.
. Mak, K.H.,
Ma, S., Heng, D., Tan, C. E., Tai, E.S., Topol, E.J., & Chew, S. K. (2007).
Impact of sex, metabolic syndrome, and diabetes mellitus on cardiovascular events.
Am J Cardiol,100(2),227-233.
. Mohan, V.,
Deepa, M., Farooq, S., Prabhakaran, D., &Reddy, K.S. (2008). Surveillance for
risk factors of cardiovascular disease among an industrial population in southern
India. Natl Med J India,21(1),8-13.
. Mohan, V.,
Deepa, M., Farooq, S., Narayan, K.M., Datta, M., &Deepa, R. (2007). Anthropometric
cut points for identification of cardiometabolic risk factors in an urban Asian
Indian population. Metabolism,56(7),961-968.
. Mohan, V.,
Sandeep, S., Deepa, R., Shah, B., & Varghese, C. (2007). Epidemiology of type
2 diabetes: Indian scenario. Indian J Med
. Mohan, V.,
Venkatraman, J.V., & Pradeepa R. (2010). Epidemiology of cardiovascular disease
in type 2 diabetes: the Indian scenario. J
Diabetes Sci Technol,4(1),158-170.
. Moss, S.E.,
Klein, R., &Klein, B.E. (1991). Cause-specific mortality in a population-based
study of diabetes. Am J Public Health,
. Peto, R.
(1994). Smoking and death: the past 40 years and the next 40. BMJ, 309(6959),937-939.
D., Yusuf, S., Mehta, S., & Pogue, J (2005). Two-year outcomes in patients admitted
with non-ST elevation acute coronary syndrome: results of the OASIS registry 1 and
2. Indian heart journal,57(3),217-225.
A., Ma, R.C., & Snehalatha, C.(2010). Diabetes in Asia. Lancet, 375(9712),408-418.
. Reddy, K.S.,
&Gupta, P. C. (2004). Tobacco Control in India. New Delhi, India: Ministry of
Health & Family Welfare, Government of India, Centers for Disease Control and
Prevention, USA and World Health Organization.
. Reddy, K.S.,
Prabhakaran, D., Chaturvedi, V., Jeemon, P., Thankappan, K. R., Ramakrishnan, L.,…
Jaison, T. M. & (2006). Methods for establishing a surveillance system for cardiovascular
diseases in Indian industrial populations. Bull
World Health Organ,84(6),461-469.
S.A. (2007). Shattuck Lecture. We can do better–improving the health of the American
people. N Engl J Med,357(12),1221-1228.
. UKPDS 32.(1998).
Ethnicity and cardiovascular disease. The incidence of myocardial infarction in
white, South Asian, and Afro-Caribbean patients with type 2 diabetes (U.K. Prospective
Diabetes Study 32). Diabetes Care,21(8),1271-1277.
D., Pais, P., Devereaux, P.J., Xie, C., Prabhakaran, D., Reddy, K.S., …Yousuf, S.(2008).
Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective
analysis of registry data. Lancet,371(9622),1435-1442.