| Background and ObjectiveDespite the continuous progress in the diagnosis and treatment of cardiovascular diseases?CVD?in recent decades,the risk of developing CVD in patients with diabetes mellitus?DM?is continuously increasing.DM is a kind of chronic metabolic disease causing hyperglycemia and multiple target organ complications,including cardiovascular disease,retinopathy,neuropathy,and kidney disease.DM remains an important independent cardiovascular risk factor after adjusting for age,smoking,body mass index,and hypertension.Compared with the general population,diabetic patients with coronary heart disease?CHD?occur earlier and have more severe lesions.The risk of excessive coronary heart disease in diabetic patients can only be partially explained by traditional cardiovascular risk factors such as hyperglycemia,dyslipidemia,hypertension and smoking.Studies have shown that the renin angiotensin-aldosterone system may play a key role in the development of coronary atherosclerosis in patients with type 2 diabetes mellitus?T2DM?.The renin-angiotensin-aldosterone system promotes coronary atherosclerosis,myocardial cell damage,and extensive myocardial fibrosis.The 2013 ESH/ESC guidelines also suggest that ACEIs and ARBs are first-line therapies for primary and secondary prevention of cardiovascular disease in patients with type 2 diabetes.However,there are few studies on angiotensin ? in patients with coronary heart disease and type 2diabetes.The specific mechanism is still inconclusive.Therefore,this study focuses on patients with coronary heart disease and type 2 diabetes,and studies the correlation between angiotensin ? and coronary artery disease.MethodsA total of 146 patients who underwent coronary angiography in the Department of Cardiology,the First Affiliated Hospital of Zhengzhou University from May 2017to August 2018,were enrolled.After admission to improve the relevant examinations and to eliminate contraindications,regular coronary angiography was performed,and the disc was recorded in real time to record the data.According to whether the patient has type 2 diabetes and coronary angiography results,there are:?1?47 patients coronary heart disease combined with type 2 diabetes group.?2?64 patients with simple coronary heart disease.?3?35 patients in the control group:non-type 2 diabetes group with negative coronary angiography results.The basic clinical data of the three groups were compared.The biochemical indicators such as blood glucose,blood lipids and uric acid and the levels of renin,angiotensin ? and aldosterone were compared.Patients with coronary heart disease and type 2 diabetes were divided into subgroups according to Gensini score,with median as the boundary,23 of which were mild lesion subgroups?Gensini score<22?,and 24 were severe lesion subgroups?Gensini score?22 points?,compare the statistical significance of the above indicators between the two groups.Patients with coronary heart disease and type 2diabetes were included in the study,and angiotensin ? and Gensini scores were analyzed.The Gensini score was used to represent the degree of coronary lesions as a dependent variable,and the above-mentioned indicators were used as independent variables for single independent variable and multi-argument logistic regression analysis.The p value<0.05 was considered statistically significant.Results1.The age,glycosylated hemoglobin,fasting plasma glucose and angiotensin ? levels in patients with coronary heart disease and type 2 diabetes are significantly higher than those in the coronary heart disease group and the control group?p<0.05?.The Gensini score in the patients with coronary heart disease complicated with type 2diabetes mellitus?31.7±28.6?and the simple coronary heart disease group?32.4±28.2?is higher than the control group?1.9±2.6?.What's more,there are no significant differences in other indicators between the three groups?all p>0.05?.Among them,angiotensin ? in coronary heart disease with type 2 diabetes group,simple coronary heart disease group and control group are:?76.1±13.5?pg·mL-1 vs?66.3±14.5?pg·mL-1 vs?67.5±16.8?pg·mL-1 vs,p=0.002].2.The levels of glycosylated hemoglobin,fasting plasma glucose and angiotensin ? in severe lesion subgroup of patients with coronary heart disease complicated with type 2 diabetes are higher than those in mild lesion?p<0.05?.There are no significant differences in other indicators between the two groups?all p>0.05?.Among them,glycosylated hemoglobin,fasting plasma glucose,angiotensin ? levels in the coronary heart disease with type 2 diabetes severe lesion subgroup and mild lesion subgroup are:glycated hemoglobin[?8.1±1.9?%vs?6.9±0.9?%,p=0.006],fasting plasma glucose[?7.1±2.5?mmol·L-1 vs?5.9±1.1?mmol·L-1,p=0.034],angiotensin ?[?81.0±11.5?pg·mL-1 vs?71.1±13.8?pg·mL-1,p=0.010].3.There is a positive correlation between angiotensin ? and Gensini score in coronary heart disease complicated with type 2 diabetes?r=0.327,p=0.025?.The difference is statistically significant.4.Single independent variable and multi-argument logistic regression analysis show that angiotensin ?[OR=1.074,95%CI?1.010,1.142?,p=0.023]shows a significant independent positive correlation with the degree of coronary artery disease.The difference is statistically significant.Conclusion1.The level of angiotensin ? in patients with coronary heart disease and type 2diabetes is significantly higher than that in patients with coronary heart disease and control group.2.The level of angiotensin ? in severe lesion subgroup of patients with coronary heart disease complicated with type 2 diabetes is higher than that in the mild lesion subgroup.3.The level of angiotensin ? in patients with coronary heart disease complicated with type 2 diabetes is independently and positively correlated with the severity of coronary artery stenosis,suggesting that angiotensin ? may play a key role in the development of coronary atherosclerosis in patients with coronary heart disease and type 2 diabetes.4.Angiotensin ? may be a simple clinical indicator for assessing the severity of coronary artery disease in patients with coronary heart disease and type 2 diabetes.The use of ACEI/ARB may help to slow the progression of coronary atherosclerosis in patients with coronary heart disease and type 2 diabetes. |
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