The Impact Of The Postprandial Lipid After Daily Breakfast On Patients With Diabetes And Stable Coronary Artery Disease

Objective:To explore the predictive factors of myocardial injury in diabetic patients with stable coronary artery disease(SCAD).Method: We enrolled patients diagnosed with diabetes mellitus(DM)and SCAD in the Cardiology Department of Shengjing Hospital from September 2016 to December 2018.We collected clinical data including gender,age,smoking history,lipid-lowering drugs,history of hypertension and myocardial infarction.Meanwhile,serious biochemical parameters such as blood lipids(fasting and postprandial),serum high-sensitivity troponin T(hs-cTnT)and N-terminal B-type natriuretic peptide(NT-proBNP)were collected.Using statistics analysis,to further analyze the influencing factors of myocardial injury in patients with DM and SCAD.Result:A total of 112 patients diagnosed with DM and SACD were enrolled in the study.The median level of serum hs-cTnT was 0.009ng/mL,(range 25 and 75 percentile: 0.006 and 0.012ng/mL).Serum hs-cTnT in 2 patients were below the detection limit,The detection rate reached 98.21%,and 16.07% of patients were above the normal range.Spearman correlation analysis showed that serum hs-cTnT was positively correlated with NT-proBNP(r=0.284,P=0.003)in patients with DM and SCAD.Postprandial serum levels of triglyceride(TG)(2.27 ± 1.06mmol/L VS 1.59 ± 0.78mmol/L,P<0.001),remnant-like particle cholesterol(RLP-C)(0.69 ± 0.29mmol/L VS 0.56 ± 0.29mmol/L,P<0.001)were significantly higher than those in fasting condition.Spearman correlation analysis showed that serum hs-cTnT level was positively correlated with postprandial TG level(r=0.399,P<0.001)and RLP-C level(r=0.242,P=0.012),and was significantly negatively correlated with postprandial high-density lipoprotein cholesterol(HDL-C)level(r=-0.367,P<0.001).Spearman correlation analysis showed that serum hs-cTnT level was significantly positively correlated with body weight(r=0.233,p=0.016),homocysteine(Hcy)(r=0.294,p=0.002),fasting blood glucose(FBG)(r=0.224,p=0.021),and negatively correlated with estimated glomerular filtration rate(eGFR)(r =-0.226,p= 0.021),mean platelet volume(MPV)(r =-0.223,p = 0.020).Logistic stepwise regression analysis showed that postprandial TG(OR=1.785,P=0.031),FBG(OR=1.630,P=0.005)and Hcy(OR=1.119,P=0.021)could be the independent predictive factors ofmyocardial injury in patients with DM and SCAD.Conclusion: Patients with DM and SCAD indeed exist myocardial injury,which may be related to the potential cardiac dysfunctoin and the increased future cardiovascular risks.Serum postprandial TG,FBG and Hcy are independent risk factors for myocardial injury in patients with DM and SCAD.