Myocardial Infarction in Diabetics, Pre-Diabetics and Non- Diabetics: A Prospective Study

ABSTRACT

Vascular diseases are one of the major public health problems in the developed world, resulting in devastating symptoms involving coronary artery occlusion, cerebrovascular accidents, peripheral vascular insufficiency, and acute myocardial infarction (AMI). These diseases affect millions of people annually, resulting in extensive morbidity and mortality. It is a well-established fact that individuals with pre-diabetes and diabetes are at a higher risk of cardiovascular events including myocardial infarction. The other risk factors for development of coronary artery disease include hypertension, obesity, hyperlipidemia, family history and sedentary life style. In this study we analyzed the data of all patients admitted for the first time for acute myocardial infarction (MI) and evaluated the load of non-diabetics, prediabetics and diabetics among them. In this study patients were analyzed for their biochemical and physiological parameters and cardiac markers at the time of admission. Methods: This was a prospective cohort study jointly conducted by department of physiology and medicine of a tertiary care medical college situated in an urban area. The patients admitted in intensive care unit and diagnosed to be having acute myocardial infarction were included in this study on the basis of a predefined inclusion and exclusion criteria. Various physiological (pulse rate, blood pressure, heart rate and respiratory rate) and biochemical (HbA1c, Plasma glucose, lipid profile and cardiac markers) were studied. Number of diabetics, pre-diabetics and non-diabetics landing in myocardial infarction and correlation of abnormal blood glucose level to severity of myocardial infarction was studied. The statistical analysis was done using SSPE 21.0 software. P value less than 0.05 was taken as statistically significant. Results: Total 89 patients were included in this study. Out of these 89 patients 34 (38.20%) patients were non- diabetic whereas 33 (37.08%) and 22 (24.72%) patients were pre-diabetic and diabetic respectively. The mean age of diabetic, pre-diabetic and non-diabetic patients were found to be comparable with no statistically significant difference amongst them (P>0.05). Gender distribution showed that there were 71 (79.78) males and 18 (20.22%) females with a MF ratio of 10.25. Heart rate as well as systolic and diastolic blood pressure and total cholesterol levels were found to be higher in diabetic patients as compared to pre diabetic and non-diabetic population. Analysis of myocardial enzyme (CK-MB and Troponin I) levels showed that they were also higher in diabetic patients as compared to pre-diabetic and non- diabetic population. Mortality was found to be statistically significantly high in patients with diabetes (P<0.05). Conclusion: The diastolic blood pressure, total cholesterol, triglyceride, LDL cholesterol CK-MB, Troponin I showed an increase in diabetic group of AMI patients. Though the mean age of myocardial infarction was found to be comparable in diabetics, pre diabetics and non-diabetic patients there was statistically significant higher mortality rates in diabetic patients with myocardial infarction.