Relationship Between Effect Of Multiple Risk Factors Intervention And Myocardial Ischemia In Type 2 Diabetes

Objectives:To observe the relationship between the effect of multiple cardiovascular risk intervention in newly diagnosed type 2 diabetes and myocardial ischemia.Methods:Selected 120 Type 2 diabetic patients from our hospital according to the selection criteria and exclusion criteria, signed informed consent form, accepted lifestyle management and intensive risk-reduction intervention. Intensive therapy goals: fast blood glucose (FBG) <7.0 mmol/L, glycosylated hemoglobin-1(cHbA1c)<7.0%, systolic blood pressure (SBP)<130mmHg, diastolic blood pressure(DBP)<85mmHg, triglyceride(TG) <150 mg/dl(1.7 mmol/L),total cholesterol(TC)<180 mg/dl(4.66 mmol/L),low dense lipid protein-cholesterol(LDL-C)<100 mg/dl(2.59 mmol/L). Drugs including: initial glucose-lowering therapy with metformin or sulfonylureas ; firstly selected blood pressure-lowering drug with ARB or ACEI;lipid metabolism adjusting with statin;using aspirin. FBG,Blood pressure,hypoglycemia event should be measured at every routine diabetes visit. HbA1c and blood lipid levels should be measured at every three months. After 8 years clinical follow-up, these patients were assessed severity of inducible myocardial ischemia using adenosine-stress single photon emission–computed tomography(SPECT) myocardial perfusion imaging (MPI) in order to analyze the relationship between the control rate of metabolism and the positive result of MPI .Results:A total of 30 patients(25%)had indusible myocardial ischemia. 61 % of 120 patients complicated with high blood pressure, 50% complicated with hypertriglyceridemia, 76% complicated with hypercholesteremia, 66% complicated with high low dense lipid protein-cholesterol blood level. 68% patients had achieved intensive target of HbA1c ,67% achieved rate of BP,25% achieved rate of TG,37% achieved rate of TC,58% achieved rate of LDL-C,all of these index had completed their intensive goal at the end of the study(HbA1c:6.56±0.95%;TG:1.58±0.89mmol/L;TC:.57±0.69mmol/L;LDL-C:2.49±0.50mmol/L , SBP : 123.57±12.50mmHg , DBP : 75.46±8.40mmHg ) .Severity hypoglycemia event rate were 1.6%,there were no primary CVD outcome. In the patients with positive result of MPI,60% were complicated with obesity(vs 29% in the patients of the negative result of MPI ,P=0.004),90% were complicated with hypercholesteremia(vs 71% in the patients of the negative result of MPI ,P=0.048).The achieved rate (all factors achieved,one factors not achieved, two factors not achieved, three factors not achieved)of all three factors(BP,lipid,HbA1c) were 31%,39%,27%,3%,positive rate of MPI during them were 7%,15%,50%,75%(P=0.000).Logistic analysis indicated that the history of chest distress (OR =49.963,95%CI=9.525～262.067,P=0.000), the poor controls of blood pressure (OR= 4.684,95%CI= 1.064～20.239,P=0.032), the total cholesterol (OR=7.297, 95%CI=1.247～42.691,P=0.027) and the mean glycosylated hemoglobin(OR=4.640,95%CI=1.064～20.239,P=0.041) were correlated with the incidence of diabetes related myocardial ischemia.Conclusion:Poor control of interventions is high risk factors of myocardial ischemia in type 2 diabetes. The more strictly and more effectively control overall cardiac risk factors would reduce the development of myocardial ischemia. Type 2 diabetic patient when appear chess distress or combined with two or more CVD risk factors should be screened for MPI.