Insulin resistance as a major determinant of increased coronary heart disease risk in postmenopausal women with Type 2 diabetes mellitus.

AIM: To investigate the risk factors associated with clinically defined coronary heart disease (CHD) in women with Type 2 diabetes mellitus (DM). METHODS: CHD status was assessed via standard history and resting electrocardiogram in 41 postmenopausal diabetic and 41 age- and body mass index-matched normoglycaemic women recruited from a community-based cohort. The following parameters were assessed: body composition by dual energy X-ray absorptiometry, blood pressure, metabolic and lipoprotein profile and haemostatic factors. RESULTS: Diabetic women with CHD (n = 14) had greater insulin resistance, calculated by homeostasis model assessment (10.2 (7.0-14.8) vs. 6.5 (5.5-7.7), P = 0.010), and higher plasminogen activator inhibitor-1 (PAI-1) levels (45 (29-69) vs. 24 (19-32) ng/ml, P = 0.013), than those without CHD. They also had higher triglycerides (2.9 (2.2-3.8) vs. 2.1 (1.8-2.4) mmol/l, P = 0.016) and a trend towards reduced low-density lipoprotein particle size (25.5 +/- 0.6 vs. 25.8 +/- 0.5 nm, P = 0.097). In a logistic regression model, insulin resistance was a significant independent predictor of CHD status (odds ratio = 1.33, 95% confidence interval = 1.06-1.68, P = 0.015). In contrast, in normoglycaemic women the major risk factors for CHD were elevated cholesterol, apolipoprotein(a), apolipoprotein B and systolic blood pressure (P = 0.018, P = 0.016, P = 0.006 and P = 0.049, respectively). CONCLUSIONS: Increased insulin resistance in association with elevated PAI-1 and dyslipidaemia appears to underpin the increased risk of CHD in women with Type 2 DM. Therapeutic approaches that increase insulin sensitivity may serve to reduce CHD risk in this vulnerable group. Diabet. Med. 18, 476-482 (2001)

Ultrasonic coronary angioplasty during coronary artery bypass grafting.

This preliminary study in 20 patients demonstrated that ultrasonic coronary angioplasty in the setting of bypass grafting is feasible, safe, and able to recanalize atherosclerotic vessels. Shorter monorail probes were superior to longer probes without guidewires in terms of success of vessel recanalization; >95% of particle debris was <25 microm in size.

Short and long-term results of coronary angioplasty in patients over 75 years.

AIMS: This report reviews the outcome of percutaneous transluminal coronary angioplasty (PTCA) on patients aged 75 years or over at this institution, in order to provide statistics that may be useful in managing elderly patients. METHODS: All elderly patients undergoing PTCA between January 1984 and December 1990 were included. Data concerning the PTCA procedure and short term (hospital stay) outcome were compared to those of all patients less than 75 years who underwent PTCA during the same period. Long term outcome was obtained for all surviving elderly patients. RESULTS: One hundred and eleven procedures were performed on patients over 75 years, compared to 3183 procedures on patients under 75. The incidence of PTCA in the elderly increased to 6.7% of all procedures in 1990. Elderly patients were more symptomatic (97% vs 79% in patients under 75 years had Canadian Cardiovascular Society grade 3 or 4 angina), more frequently had the procedure performed urgently (39% vs 14%) and often (67%) had risk factors for PTCA (3 vessel disease, significant left ventricular dysfunction, or a complicating medical illness). Primary success rates (86% vs 90% in patients under 75 years), urgent coronary artery bypass grafting (1.8% vs 1.9%) and Q wave infarction (1.8% vs 1.0%) were similar in the two age groups. In the elderly, procedural difficulties requiring non standard equipment were common (61%), and in-hospital mortality was increased (4.5% vs 0.7%). Additionally, three patients died after discharge resulting in a 30 day mortality of 7.2%. A favourable long term outcome was obtained in 50% of patients at a mean follow up of 20 months. Unfavourable or neutral outcome was due to one or more of the following; death (16%), coronary artery bypass grafting (19%), acute myocardial infarction (7.5%) or significant residual angina (17%). CONCLUSIONS: Highly symptomatic patients over 75 years constitute a high risk group for PTCA, with approximately half obtaining a favourable long term outcome.

Effects of low-dose aspirin on restenosis after coronary angioplasty.

After angioplasty of a previously untreated native coronary artery and after 2 weeks of aspirin therapy, 216 subjects (aged less than 70 years without acute infarction) were randomized to treatment with soluble aspirin, 100 mg/day, or placebo to study the effect on restenosis. Follow-up, defined as angiography at 6 months, earlier angiographic restenosis or coronary bypass surgery was completed by 108 aspirin- and 104 placebo-treated patients. Restenosis (stenosis greater than or equal to 50% plus loss of greater than or equal to 50% of gain, or surgery) occurred in 38 (35%) aspirin- and 45 (43%) placebo-treated subjects (p = not significant). No patient died. Restenosis occurred in 42 of 168 (25%) aspirin- and 51 of 135 (38%) placebo-treated lesions (p less than 0.025). Aspirin-treated lesions (n = 163) had lost 16 +/- 22% (mean +/- standard deviation) of lumen and placebo-treated lesions 22 +/- 25% of lumen (n = 134) at angiography (p less than 0.01). There were more left anterior descending lesions in the placebo group and these had a higher recurrence rate than other lesions. The beneficial effect of aspirin was not dependent on this, although significance was reduced in subgroup analysis. Loss of lumen in left anterior descending lesions was 20 +/- 24% (n = 57) in the aspirin-treated and 27 +/- 25% (n = 70) in the placebo-treated lesions (p less than 0.1). It is concluded that there is a small beneficial effect of low-dose aspirin on restenosis after coronary angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Q waves and ventricular extrasystoles in resting electrocardiograms. A 16 year follow up in Busselton study.

Isolated abnormalitites in the resting electrocardiograms of 1546 Busselton people with no history of angina or past myocardial infarction were examined in relation to 16 year mortality. Multivariate discriminate analysis in men showed significant independent relationship for Q waves with coronary heart disease and for ventricular extrasystoles with cardiovascular disease. In women multivariate analysis showed significant relations for ventricular extrasystoles with total mortality and coronary heart disease. There were higher trends in mortality for both men and women with frequent ventricular extrasystoles compared with those with infrequent ventricular extrasystoles.

Electrocardiograms and 13 year cardiovascular mortality in Busselton study.

In 2119 unselected Busselton subjects 40 to 79 years of age, the 13 year mortality from cardiovascular disease was significantly higher in those whose initial electrocardiogram showed Q and QS patterns, left axis deviation, ST depression, T wave depression, flat or biphasic T waves, atrial fibrillation or flutter, and ventricular extrasystoles. In angina-free subjects whose electrocardiographic codes occurred in isolation from any other electrocardiographic abnormality, ventricular extrasystoles were associated with significantly higher mortality from cardiovascular disease compared with controls.