Résumé
Megjor risk factors explain much of the excess risk for coronary heart disease produced by diabetes, but nontraditional factors may also relate to incident coronary heart disease. This study was conducted on 35 patients with IDDM and coronary heart disease [CHD] [10 females and 25 males, aged 45-70 years], 35 patients with IDDM and without CHD [17 females and 18 males, aged 35-65 years] as well as 20 age and sex matched apparently healthy individuals as a control group. Every individual was subjected to clinical evaluation including history taking and clinical examination with special stress on the presence of risk factors as well as measurement of: fasting and postprandial blood glucose levels, lipid profile, serum albumin level glycosylated hemoglobin [HbA[1]], C-reactive protein [CRP], fibrinogen level von Willebrand factor antigen level [vWF Ag], total leucocyte count and albumin excretion rate [AER] in urine. Insulin dependent diabetics with CHD had higher levels of total cholesterol LDL-c and triglycerides and had lower levels of HDL-c when compared with diabetics without CHD and with controls. They also showed higher levels of fibrinogen, vWFAg level, CRP and total leucocyte count and lower levels of serum albumin. Microalbuminuria was present in 71.4% of diabetics who developed CHD while it was present in 31.4% of diabetics without CHD. In diabetics with CHD, fibrinogen was correlated with vWF at r=0.52 and P< 0.05. vWF Ag level is weakly correlated to lipid parameters, being significantly correlated to triglycerides. It was also positively correlated toAER [microalbwninuria] [r=0.84, P< 0.003], while it was negatively correlated to serum albumin [r = -0.4, P< 0.05]. In the type I diabetic group with CHD C-reactive protein correlated significantly with vWF [r=0.43, P< 0.005] and with fibrinogen [r=0.60, P< 0.001]. In conclusion levels of fibrinogen, von Willebrand factor, CRP, albumin and leucocyte count were predictors of coronary heart disease among patients with IDDM. These associations may reflect the underlying inflammatory reaction or microvascular injury related to atherosclerosis and a tendency toward thrombosis