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. 2009 Sep 7:8:48.
doi: 10.1186/1475-2840-8-48.

Hemostatic risk factors in patients with coronary artery disease and type 2 diabetes - a two year follow-up of 243 patients

Thomas W Jax  1 , Ansgar J Peters, Gunnar Plehn, Frank-Chris Schoebel
Affiliations

Hemostatic risk factors in patients with coronary artery disease and type 2 diabetes - a two year follow-up of 243 patients

Thomas W Jax et al. Cardiovasc Diabetol. .

Abstract

Background: Thrombosis is regarded to be a key factor in the development of acute coronary syndromes in patients with coronary artery disease (CAD). We hypothesize, that hemostatic and rheological risk factors may be of major relevance for the incidence and the risk stratification of these patients.

Methods: In 243 patients with coronary artery disease and stable angina pectoris parameters of metabolism, hemostasis, blood rheology and endogenous fibrinolysis were assessed. Patients were prospectively followed for 2 years in respect to elective revascularizations and acute coronary syndromes.

Results: During follow-up 88 patients presented with cardiac events, 22 of those were admitted to the hospital because of acute events, 5 Patients were excluded due to non- cardiac death. Patients with clinical events were found to be more frequently diabetic and presented with a more progressed coronary atherosclerosis. Even though patients with diabetes mellitus demonstrated a comparable level of multivessel disease (71% vs. 70%) the rate of elective revascularization was higher (41% vs. 28%, p < 0.05). The results were also unfavorable for the incidence of acute cardiovascular events (18% vs. 8%, p < 0.01). In comparison to non-diabetic patients diabetics demonstrated significantly elevated levels of fibrinogen (352 +/- 76 vs. 312 +/- 64 mg/dl, p < 0.01), plasma viscosity (1.38 +/- 0.23 vs. 1.31 +/- 0.16 mPas, p < 0.01), red blood cell aggregation (13.2 +/- 2.5 vs. 12.1 +/- 3.1 E, p < 0.05) and plasmin-activator-inhibitor (6.11 +/- 3.4 vs. 4.7 +/- 2.7 U/l, p < 0.05).

Conclusion: Pathological alterations of fibrinogen, blood rheology and plasminogen-activator-inhibitor as indicators of a procoagulant state are of major relevance for the short-term incidence of cardiac events, especially in patients with diabetes mellitus type 2, and may be used to stratify patients to specific therapies.

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Figures

Figure 1
Figure 1
clinical events in 243 patients. Elective revascularizations include aorto-coronary bypass operation and angioplasty, acute events include unstable angina pectoris, acute myocardial infarction and cardiac death.
Figure 2
Figure 2
clinical events for patients with and without diabetes mellitus. Elective revascularizations include aorto-coronary bypass operation and angioplasty, acute events include unstable angina pectoris, acute myocardial infarction and cardiac death.
Figure 3
Figure 3
Rheology in diabetic patients. Between Patients with and without type 2 diabetes mellitus significant differences were found for fibrinogen (A), red blood cell (RBC) aggregation (B), plasma viscosity (C) and Plasminogenactivator-Inhibitor (PAI) (D).
Figure 4
Figure 4
Balance and dysbalance of hemostasis in diabetes.
See this image and copyright information in PMC

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