The relation between impaired glucose tolerance and slow coronary flow

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Abstract

Background

Impaired glucose tolerance is a preliminary stage in the development of type 2 diabetes mellitus and has been shown to increase the risk of cardiovascular morbidity and mortality in addition to causing endothelial dysfunction. In this study, we sought to determine if impaired glucose tolerance is related to slow coronary flow, an angiographic phenomenon caused by coronary micro and macrovascular endothelial dysfunction.

Methods

The population of this prospective study consisted of 28 patients with documented slow coronary flow, defined according to TIMI frame count method, [20 (71.4%) males; 51 ± 9 years] and 30 patients with normal coronary flow [17 (56.6%) males; 47 ± 6 years]. All study patients underwent an oral glucose tolerance test after 12 h of fasting. Lipid profile, hemoglobin A1c and systemic blood pressure were measured in all patients.

Results

There was no difference between two groups with respect to age, fasting plasma glucose, triglyceride, total cholesterol, high density lipoprotein, low density lipoprotein, hemoglobin A1c, systolic–diastolic blood pressure levels, history of smoking and alcohol consumption. Plasma glucose at 2 h of oral glucose tolerance test was significantly higher in slow coronary flow patients compared to control group (145 ± 44 vs. 112 ± 38 mg/dl, P = 0.001, respectively). In addition, the number of patients who met the criteria of impaired glucose tolerance was significantly higher in slow coronary flow patient group [16 (57%) vs. 7 (23%), P = 0.002, respectively).

Conclusions

Our results suggest that impaired glucose tolerance may be an independent etiological factor for slow coronary flow phenomenon.

Introduction

Slow coronary flow is an angiographic finding characterized by delayed opacification of coronary arteries in the absence of epicardial occlusive disease [1]. Data show that slow coronary flow is a result of micro and macrovascular endothelial dysfunction of the coronary arteries [2], [3], [4], [5], [6]. Although many studies focusing on the pathophysiology of this unique angiographic phenomenon were done, studies investigating etiological factors are scarce.

Diabetes mellitus is a major risk factor for coronary artery disease, which is the leading cause of mortality among diabetic patients [7], [8]. Diabetes has a deleterious effect on vascular function, thereby increasing the potential for coronary vasoconstriction and thrombosis. There is consistent evidence that coronary vascular dysfunction caused by diabetes precedes clinically overt coronary artery disease, suggesting that it may be an early marker of atherosclerosis [9], [10], [11], [12]. Impaired glucose tolerance is a preliminary stage in the development of type 2 diabetes mellitus and a risk factor for the disease. New data show that impaired glucose tolerance may be casually related to coronary vascular dysfunction, which is an independent risk factor for micro and macrovascular disease and confers increased cardiovascular mortality [13], [14], [15].

The objective of this study was to investigate the relation between impaired glucose tolerance and slow coronary flow. To our knowledge, a study exploring this topic is not present in the literature.

Section snippets

Study population

Our study population consisted of 28 patients with normal coronary arteries but documented slow coronary flow on coronary arteriography {20 (%71.4) male, 51 ± 9 years} and 30 control group patients with normal coronary arteries and normal coronary flow {17 (%56.6) male, 47 ± 6 years}. Normal coronary artery was defined as that without any visible plaques or luminal irregularities. All patients underwent coronary arteriography because of typical or atypical angina. Fasting venous blood glucose of

Results

Age, sex, history of smoking, alcohol consumption, blood pressure, total cholesterol, low density lipoprotein, high density lipoprotein, triglyceride, fasting plasma glucose, hemoglobin A1c levels were similar in both groups. Baseline characteristics are listed in Table 1.

Of the 28 study patients, 25 had slow coronary flow in left anterior descending artery, 23 in circumflex and 21 in right coronary artery. 17 patients had slow coronary flow in three vessels, 7 in two and 4 in one.

Although

Discussion

Slow coronary flow is a phenomenon characterized by delayed opacification of epicardial coronary arteries during selective coronary angiography in the absence of obstructive epicardial coronary disease. It was first described by Tambe et al. [1], who suggested abnormally high small vessel resistance due to impairment of coronary microcirculation. Following investigators, focusing on biopsy samples of slow coronary flow patients, observed fibromuscular hyperplasia, medial hypertrophy, myointimal

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