Elsevier

American Heart Journal

Volume 145, Issue 2, February 2003, Pages 285-291
American Heart Journal

Clinical Investigations: Interventional Cardiology
Prevalence, predictors, and consequences of unrecognized diabetes mellitus in 3266 patients scheduled for coronary angiography,☆☆,,★★

Presented in part at the 35th Annual Convention of the Deutsche Diabetesgesellschaft, Munich 2000.
https://doi.org/10.1067/mhj.2003.134Get rights and content

Abstract

Background Previous population-based studies have reported a proportion of undiagnosed diabetes in the range between 25% and 50%. However, data on undiagnosed diabetes in a high-risk population, such as patients scheduled for coronary angiography, are lacking. Therefore, we sought to determine prevalence, predictors, and consequences of unrecognized diabetes in patients scheduled for coronary angiography. Methods This analysis involved 3266 patients scheduled for coronary angiography who have been enrolled in the Ludwigshafen Risk and Cardiovascular Health study. Results Five hundred fifty-six patients (17.0%) had known diabetes. Another 486 patients with previously unrecognized diabetes (17.9%) were diagnosed in the remaining 2710 presumed nondiabetic subjects. Therefore, 486 (46.6%) of a total of 1042 patients with diabetes were previously undiagnosed, raising the diabetic proportion of enrolled patients to 31.9%. In half of the newly diagnosed patients with diabetes, the disease was detectable only by use of glucose challenge. Independent predictors of unrecognized type 2 diabetes were C-reactive protein >5 mg/L, arterial hypertension, body mass index >30 kg/m2, age ≥65 years, and a positive family history of diabetes. Compared with nondiabetic subjects, patients with unrecognized type 2 diabetes showed a significantly increased risk for coronary artery disease (odds ration [OR] 1.7, 95% CI 1.3-2.3) and multivessel disease (OR 1.4, 95% CI 1.1-1.8), and a borderline association with myocardial infarction (OR 1.2, 95% CI 1.0-1.5). Oral glucose challenge was not superior to fasting glucose in predicting this increased cardiovascular risk. Conclusion In half of the patients scheduled for coronary angiography, diabetes was previously unrecognized. In a high-risk population of patients scheduled for coronary angiography, screening for diabetes should be performed routinely to initiate timely preventive efforts. (Am Heart J 2003;145:285-91.)

Section snippets

Methods

The Ludwigshafen Risk and Cardiovascular Health Study (LURIC)20 enrolled 3316 consecutive patients admitted for coronary angiography at the Ludwigshafen Heart Center between 1997 and 1999 to investigate traditional and new cardiovascular risk factors including various gene polymorphisms. Patients were enrolled after written informed consent. The study was approved by the ethics committee of the federal state of Rheinland Pfalz physicians' board (Landesärztekammer Rheinland-Pfalz).

After

Results

A total of 3266 patients fulfilled inclusion criteria of the LURIC study.

Discussion

In consecutive patients scheduled for coronary angiography, we observed as many patients with undiagnosed diabetes as patients with known diabetes, raising the proportion of patients with diabetes to about one third. Newly diagnosed diabetes is characterized by an intermediate coronary pathology and a borderline association with myocardial infarction. Screening for diabetes at this stage provides a unique opportunity for starting preventive efforts against the further diabetes-associated

Acknowledgements

The authors are indebted to B. Ksoll, S. Veth, N. Leonhardt, and A. Bilir for invaluable technical assistance.

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  • Cited by (0)

    Supported in part by grants from the Deutsche Forschungsgemeinschaft (SFB 518) and the Deutsche Diabetesgesellschaft.

    ☆☆

    Reprint requests: Gunnar Taubert, MD, Herzzentrum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen, Germany.

    E-mail: [email protected]

    ★★

    0002-8703/2003/$30.00 + 0

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