Pirbhat Shams1, Osman Faheem1, Ghufran Adnan1, Jamshed Ali1, Maria Khan1
1The Aga Khan University Hospital, Karachi, Pakistan
Diabetes Mellitus (DM) is considered as coronary artery disease equivalent. It carries prognostic value in coronary artery diseases (CAD) and patients with diabetes (DM) and CVD do worse than patients with CAD alone.
A retrospective analysis was done for all patients presenting with CVD reasons or symptoms to emergency department of the hospital for month of March-April 2019 and March-April 2020. Basic demographics, CVD status and final CV diagnosis was recorded.
Records of 1354 patients were recruited and analyzed. The prevalence of DM in this cohort was 47.9%. Mean age was 61.28 years. Female gender constituted 40.6%. The prevalence of DM in this cohort was 47.9%. In sub-group analysis, 45.7% (372) of males and 49.3% (277) of females were diabetic. 64.2% patients had both prior IHD and DM, 39.6% had DM but not IHD and 35.8% had IHD but no DM. Percentage of hypertensive patients with DM was 61.9 % in contrast to 38.1% patients without DM. CKD patients were strikingly diabetics (81.3%). Proportion of DM in patients with prior revascularization in form of percutaneous coronary angioplasty or coronary artery bypass grafting was 64.7%. Patients with DM were less likely to present with typical chest pain and were more likely to present with shortness of breath. On final evaluation by cardiologists, following observations were made with regard to DM status: DM was more common with NSTEMI than STEMI (60.6% vs. 45.5%). Likewise, heart failure (58.8% vs. 41.2%), type II myocardial infarction or injury (55.5% vs. 44.5%) was more common with diabetics than non-diabetics. Tachyarrhythmias (63.2% vs. 36.8%), unstable angina (53.4% vs. 46.6%) and valvular heart diseases (81.8% vs. 18.2%) were more common with non-diabetics.
DM is a major modifiable risk factor for CAD in south-Asian cohort and carries very high prevalence in this part of the world. Stringent measures for DM control should be employed for primary and secondary prevention of CAD. Physicians should be aware of atypical presentation of these patients with acute coronary syndrome.