Coronary macroangiopathy in the context of the different clusters of Diabetes Mellitus and its association with the microvascular complications of the disease

Abstract

Cardiovascular diseases are the main causes of morbidity and mortality both in the general population and in patients with Diabetes Mellitus (DM), being coronary artery disease one of the main forms of presentation. Among patients undergoing a coronary angiography after an episode of acute coronary syndrome, approximately 25% are diagnosed with DM. The coronary of these individuals usually presents a complex angiographic pattern, with diffuse and multivessel atherosclerotic plaques, that often extend to distal arterial branches. Diabetic macroangiopathy starts early, still during the dysglycemic stage and it is responsible for approximately 80% of all deaths among patients diagnosed with diabetes. Although genetic susceptibility and the presence of other metabolic abnormalities are involved in the atherosclerosis process, prolonged exposure to hyperglycemia and insulin resistance are potentially the main factors involved in the progression of atherosclerosis in these patients. The heterogeneity in the etiopathogenesis of different types of DM with various degrees of insulin deficiency, insulin resistance and inflammation (autoimmune or not) may have different pathophysiologic impacts on cardiovascular outcomes. In this way, a new classification of DM into five clusters based on clinical and laboratory parameters of clinical practice, demonstrated differences in the progression and in the risk of complications related to among the DM subgroups, thus suggesting that this new method of classify diabetes may help to define preventive and therapeutic strategies.In this context, with this project, we sought to validate the clustering approach in a group of Brazilian patients with coronary artery disease and characterize the presence or progression of other complications associated with DM. At the same time, we intend to characterize coronary disease in each cluster in terms of angiographic impairment and prevalence, since findings in the literature regarding cardiovascular outcomes in each cluster are divergent. An important point of this study is that all the parameters studied are already available in routine clinical follow-up and will enable the physician to detect patients who would potentially benefit from early and individualized intervention for their cardiometabolic condition. (AU)