PECULIARITIES OF TREATMENT OF CORONARY ARTERY DISEASE WITH CONCOMITANT TYPE 2 DIABETES MELLITUS WITH ANGIOTENSIN RECEPTOR BLOCKERS

Abstract

Introduction: the relevance of determining peculiarities of treatment of coronary artery disease with concomitant type 2 diabetes mellitus is high, as it solves several important medical, social and economic problems of society. The aim: of research was to evaluate state of heart function (development of heart failure) and changes in glucose metabolism in patients with CAD with concomitant type II DM depending on diabetes stage and treatments with telmisartan and valsartan. Materials and methods: Study included 106 patients with coronary artery diseases and type II DM with mean age 68.8±8.9 years; mean age of males (46.2 %) was 65.2±9.0 years and females (53.8 %) — 71.6±7.8 years. All patients were treated in cardiology department of CME “City clinical hospital № 27” of Kharkiv city government, which is clinical base of Departments of internal medicine № 2, clinical immunology and allergology of L. T. Malaya of Kharkiv National Medical University. All patients were divided into 4 groups depending on stage of diabetes. First group included patients with CAD and with no concomitant DM (n=36; mean age = 66.4±10.1 years); second — CAD and mild course of DM (n=21; mean age = 71.9±9.4 years); third group included patients with CAD and moderate DM (n=28; mean age = 69.7±8.0 years); and fourth group — patients with CAD and severe DM (n=21; mean age = 67.9±6.5 years). Results: After treatment with valsartan and telmisartan no difference was observed in SBP, DBP and HR in both valsartan and telmisartan patients. However, it is obvious that levels of described variables mostly normalized, which suggests on high effectiveness of performed treatment. Comparison of initial and post-treatment data showed significant changes observed both in heart function and glucose metabolism. It was found that valsartan users showed significant decrease in SBP, DBP and HR in patients with CAD only and CAD with moderate T2DM. In all patients suggest that valsartan users will show decrease of HbA1c independently on DM stage, while telmisartan provides normalization of HbA1c only in moderate to severe DM patients. This suggests that telmisartan acts as protective and repairing medication in patients with concomitant CAD and T2DM, predominantly in moderate to severe stages of DM; valsartan increases cardiac function mostly in CAD only patients and in mild to severe DM, but influence on systolic and diastolic function was not found. Conclusions: Our study demonstrates strong connection between glucose metabolism and heart function. It was shown that stage of T2DM significantly influence indices of morphological state of heart with effects on development of systolic and, predominantly, diastolic dysfunction, which further leads to development of heart failure. Moreover, it was shown, that treatments of patients with CAD with concomitant T2DM of different stages with ARBs (valsartan and telmisartan) provides protective effects on heart muscle and glucose metabolism. Study found significant correlations between levels of blood pressure, systolic and diastolic function and levels of glucose and HbA1c in patients with different stages of T2DM.