Clinical manifestations and risk factors of coronary artery disease in patients with diabetes mellitus in western Siberia.

OBJECTIVE: To compare the prevalence of cardiovascular risk factors and clinical manifestations of coronary artery disease (CAD) between patients with type 2 diabetes mellitus (DM) and CAD who lived at northern latitudes vs. those who resided at southern latitudes in the Tyumen region, western Siberia. STUDY DESIGN: This retrospective study involved 382 patients with type 2 DM selected from 8,573 patients with angiographic CAD (>50% stenosis). Out of the total, 243 patients were permanent residents at the high latitudes of the Tyumen region ("northern patients"), and 139 patients were permanent residents in areas south of the Tyumen region ("southern patients"). RESULTS: On average, northern patients were younger than southern patients (53 vs. 57 years, respectively). The odds ratio (OR) for living in the north was 2.1 (95% CI 0.99-4.53) for obesity (BMI>or=30 kg/m2), 1.87 (95% CI 1.05-3.31) for smoking, 0.93 (95% CI 0.89-0.96) per 1 year increase in age, 0.84 (95% CI 0.76-0.94) per 1 mmol/L increase of fasting plasma glucose, and 1.15 (95% CI 1.04-1.28) per 1 mm increase of right ventricular end-diastolic diameter. The proportion of patients with 3 or more CAD risk factors was higher in the north. Most patients in both groups had a history of myocardial infarction, severe angina in class III/IV as defined by the Canadian Cardiovascular System (CCS), heart failure in class II/IV as defined by the New York Heart Association (NYHA) and hypertension. CONCLUSIONS: A north-south gradient was observed in cardiovascular risk factors among patients with DM and CAD in the Tyumen region. The clinical manifestations of CAD in DM patients at high latitudes were comparable with those of patients who reside south of the Tyumen region of western Siberia, despite the younger age of northern patients.

Asymmetric septal hypertrophy in patients with coronary artery disease.

AIMS: To assess the relationship between asymmetric septal hypertrophy (ASH) and manifestations of coronary artery disease (CAD). METHODS AND RESULTS: A total of 5128 consecutive patients with proven diagnosis of CAD were examined. There were 2469 patients with left ventricular (LV) hypertrophy (LVH) (48.2%), among whom 297 (5.8%) had ASH (echocardiographic ventricular septum thickness to LV posterior wall thickness ratio > or =1.3). There were more male patients with ASH than patients with symmetric LVH (SLVH). ASH patients were significantly older and more obese, more of them were in NYHA class III/IV compared with SLVH patients. The prevalence of prior myocardial infarction (MI), systemic hypertension, heart rhythm disorders were higher in patients with ASH compared with SLVH patients. The groups differed significantly in echocardiographic parameters: LV and right ventricular (RV) end-diastolic dimensions, LV ejection fraction, left atrial dimension, extent of LV wall motion abnormalities, wall motion score index, LV mass/body surface area, signs of prior MI, and frequency of moderate mitral regurgitation. The frequency of stenosis and more severe (>90% stenosis) lesion of right coronary artery (RCA) and left circumflex artery (LCA) were higher in patients with ASH. Multivariate analysis identified that heart rhythm disorder, LV and RV end-diastolic dimensions, aortic root diameter, impaired LV ejection fraction, echocardiographic signs of previous MI, LV mass, and severe lesions of RCA were independently associated with ASH. CONCLUSION: In patients with CAD, ASH is associated with significant atherosclerosis of RCA and LCA, and more severe clinical manifestations of CAD and impaired LV function.