Carbohydrate metabolism disorders and coronary collateral circulation in patients with chronic coronary artery disease

Aim.
To evaluate the association between coronary collateral circulation (CCC) and carbohydrate metabolism disorders (CMD) in patients with chronic coronary artery disease (CAD).
Materials and Methods.
Six hundred three patients with chronic CAD were included in this cohort cross-sectional study. Coronary angiography images were used to quantify coronary circulation, including CCC evaluation, with a modified technique proposed by Rentrop. CMD were classified according to the WHO criteria.Potential associations between CMD and CCC were evaluated using multiple linear models that incorporated major angiographic, clinical and laboratory parameters.
Results.
Among the 603 patients with chronic CAD, 47.4 had CMD, including type 2 diabetes mellitus in 24.2% of the patients, impaired glucose tolerance in 2.8%, type 1 diabetes mellitus in 1.0% and unspecified CMD in 16.1%. CMD were independently associated with lower CCC [odds ratio (OR).
= 0.96, p .
= 0.003). CMD were independently associated with a decrease in the association .
between maximum diameter stenosis and CCC (OR = 0.93, p.
= 0.005). No independent associations were found between CCC and type of anti-diabetic treatment, HbA_1c levels, insulin resistance (HOMA index), or metabolic syndrome components (body mass index, triglycerides, fasting glucose levels, LDLP cholesterol and arterial hypertension).
Conclusion.
CMD in patients with chronic CAD are .
independently associated with worse CCC. The presence of CMD weakens .
the association between maximum diameter stenosis and CCC. Metabolic syndrome components, blood glucose control and anti-diabetic treatment modality were not found to influence CCC.

collateral circulation, carbohydrate metabolism, coronary artery disease

1. Meier P, Hemingway H, Lansky AJ, et al. The impact of the coronary collateral circulation on mortality: a meta-analysis. European heart journal. 2012;33(5):614-621. doi: 10.1093/eurheartj/ehr308

2. Meier P, Gloekler S, Zbinden R, et al. Beneficial effect of recruitable collaterals: a 10-year follow-up study in patients with stable coronary artery disease undergoing quantitative collateral measurements. Circulation. 2007;116(9):975-983. doi: 10.1161/circulationaha.107.703959

3. Helfant RH, Vokonas P, S., Gorlin R. Functional importance of the human coronary collateral circulation. New England Journal of Medicine. 1971;284(23):1277-1281. doi: doi:10.1056/NEJM197106102842301

4. Pohl T, Seiler C, Billinger M, et al. Frequency distribution of collateral flow and factors influencing collateral channel development: Functional collateral channel measurement in 450 patients with coronary artery disease. Journal of the American College of Cardiology. 2001;38(7):1872-1878. doi: 10.1016/S0735-1097(01)01675-8

5. Yilmaz MB, Caldir V, Guray Y, et al. Relation of coronary collateral vessel development in patients with a totally occluded right coronary artery to the metabolic syndrome. American Journal of Cardiology.97(5):636-639. doi: 10.1016/j.amjcard.2005.09.103

6. Sasmaz H, Yilmaz MB. Coronary collaterals in obese patients: impact of metabolic syndrome. Angiology. 2009;60(2):164-168. doi: 10.1177/0003319708316007

7. Mouquet F, Cuilleret F, Susen S, et al. Metabolic syndrome and collateral vessel formation in patients with documented occluded coronary arteries: association with hyperglycaemia, insulin-resistance, adiponectin and plasminogen activator inhibitor-1. European heart journal. 2009;30(7):840-849. doi: 10.1093/eurheartj/ehn569

8. Reed R, Kolz C, Potter B, et al. The mechanistic basis for the disparate effects of angiotensin ii on coronary collateral growth. Arteriosclerosis, thrombosis, and vascular biology. 2008;28(1):61-67. doi: 10.1161/atvbaha.107.154294

9. Weihrauch D, Lohr NL, Mraovic B, et al. Chronic hyperglycemia attenuates coronary collateral development and impairs proliferative properties of myocardial interstitial fluid by production of angiostatin. Circulation. 2004;109(19):2343-2348. doi: 10.1161/01.cir.0000129225.67353.1f

10. Lin TH, Wang CL, Su HM, et al. Functional vascular endothelial growth factor gene polymorphisms and diabetes: Effect on coronary collaterals in patients with significant coronary artery disease. Clin Chim Acta. 2010;411(21–22):1688-1693. doi: 10.1016/j.cca.2010.07.002

11. Hsu PC, Su HM, Lin TH. Association between coronary collaterals and serum uric acid level in chinese population with acute coronary syndrome. Angiology. 2013;64(4):323-324. doi: 10.1177/0003319712463263

12. Дедов И.И., Шестакова М.В., Александров А.А., и др. Алгоритмы специализированной помощи больным сахарным диабетом. // Сахарный диабет. - 2011. - №3 (приложение 1). – С.4-72. [Dedov II, Shestakova MV, Aleksandrov AA, et al. Algorithms of Specialized Medical Care for Diabetes Mellitus Patients. Diabetes mellitus. 2011;14(3s):2-72. ] doi: 10.14341/2072-0351-5612

13. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia.1985;28(7):412-419.

14. Vittinghoff E, Glidden DV, Shiboski SC, et al. Regression Methodsin Biostatistics, 2nd ed.; Springer: USA; 2012. p.418-420.

15. StataCorp. Stata Statistical Software: Release 9. StataCorp LP, College Station, TX (2011).

16. Schmidt M, Johannesdottir SA, Lemeshow S, et al. Obesity in young men, and individual and combined risks of type 2 diabetes, cardiovascular morbidity and death before 55 years of age: a Danish 33-year follow-up study. BMJ Open. 2013;3(4):e002698. doi: 10.1136/bmjopen-2013-002698

17. Harjai KJ, Stone GW, Boura J, et al. Comparison of outcomes of diabetic and nondiabetic patients undergoing primary angioplasty for acute myocardial infarction. American Journal of Cardiology. 2003;91(9):1041-1045. doi: 10.1016/S0002-9149(03)00145-0

18. Старостин И.В., Талицкий К.А., Булкина О.С., и др. Нарушения углеводного обмена и коллатеральный кровоток в миокарде. // Сахарный диабет. – 2013. - №1 – С.19-26. [Starostin IV, Talitskiy KA, Bulkina OS, et al. Glycemic disorders and coronary collateral circulation. Diabetes mellitus. 2013;16(1):19-26.] doi: 10.14341/2072-0351-3592

19. Davis CA, Sherman AJ, Yaroshenko Y, et al. Coronary vascular responsiveness to adenosine is impaired additively by blockade of nitric oxide synthesis and a sulfonylurea. Journal of the American College of Cardiology. 1998;31(4):816-822. doi: http://dx.doi.org/10.1016/S0735-1097(97)00561-5