Do obesity, hypertension and dyslipidemia pose significant risks for coronary artery disease among Bangladeshi diabetics?
Authors: Banu Akhter , Hoque Fazlul , Ahsan Khandoker Abul , Sayeed M Abu 
Published: September 2022

Background and objectives: For decades the global population has been experiencing diabetic epidemic. The risks related to obesity, diabetes mellitus (DM) and coronary artery diseases (CAD) are well known. This study aimed to assess the prevalence of coronary artery disease (CAD) and its related risks in Bangladeshi diabetics.

Materials and methods: The study was conducted at Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), a largest referral center for diabetes in Bangladesh. Socio-demographic and clinical history including biochemical investigation report were collected from the BIRDEM registry. The eligible criteria of study participants were: age 30 – 60 year, having DM, non-smoker, free from retinopathy, nephropathy and neuropathy. The prevalence of CAD, systolic hypertension (SHTN) and diastolic hypertension (DHTN) in the registered diabetic patients were estimated. Additionally, the study addressed the risk and predictors of CAD among those with DM.

Investigations included – anthropometry, blood pressure, blood glucose, serum lipids and electrocardiogram (ECG). CAD was diagnosed on: (a) history of angina plus positive ECG - either on rest or on stress, post-myocardial infarction (MI) with Q-wave MI or non-Q-MI or echocardiographic evidences. Lipids namely triglycerides (TG), total cholesterol (T-Chol), high density lipoproteins (HDL) and low-density lipoproteins (LDL) were estimated by Hitachi-704 auto-analyzer using enzymatic method.

Results: A total of 693 (M /W =295/398) participants volunteered. The prevalence of CAD, SHTN, DHTN and mean arterial hypertension (MAH) were 18.6%, 23.2%, 13.6% and 17.7%, respectively. Their mean (±SD) values of age, body mass index (BMI - kg/m2), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and mean arterial pressure (MAP) were 47 (8.6) years, 24.6 (3.5), 0.98(0.05), 0.56(0.06) and 101(11.3) mmHg, respectively. The mean (±SD) of FBG (mmol/L), T-Chol, TG and HDL (mg/dl) were 10.2 ± 4.0, 206 ± 44, 218 ± 86 and 47.5 ± 9.3 respectively. The women had significantly higher BMI (p<0.001), WHtR (p<0.001), SBP (<0.001), MAP (p<0.001), T-Chol (p<0.001) and TG (p=0.043) than men. The risk variables were categorized into quartiles and Chi-sq trend determined whether the increasing prevalence of CAD were significant. Higher quartile of age was found consistently significant (p<0.001). Of the obesity indices, only higher quartile of WHtR was significant (p< 0.05). For BP measures, higher MAP quartiles showed the trend significant (p<0.001). Likewise, for lipids, higher quartiles of TG (p<0.001) and lower quartile of HDL (p<0.001) were significant.

Finally, logistic regression estimated the risk related to CAD. The highest age-quintile (>55y: 95% CI: 1.09 - 43.7) and highest TG-quintile (281mg/dl: 95% CI: 1.45-59.7) were proved to be significant predictor of CAD and HDL highest quintile (>54mg/dl) was proved to be significant protecting factor for CAD (95% CI: 0.005-0.583).

Conclusion: The study observed the importance of MAP, TG, HDL, T-Chol/HDLR (T-Chol -to HDL ratio) and TG/HDLR (triglycerides-to HDL ratio) as risks for CAD among diabetics. Further study with investigations of echocardiogram, ETT, coronary angiogram and coronary calcium scoring would be helpful in confirming these findings related to CAD risks.

IMC J Med Sci. 2023; 17(1): 002. DOI: https://doi.org/10.55010/imcjms.17.002

*Correspondence: M Abu Sayeed, Department of Community Medicine, Ibrahim Medical College, 1/A, Ibrahim Sarani, Segunbagicha, Dhaka 1000, Bangladesh. Email: sayeed1950@gmail.com