Rashid Amna, Saeed Muhammad Salman, Ghouse Mohamed Arshad, Kunju Arman K, Umar Nuh, Asif Abdul Eizad, Naveed Bisma, Asif Haiqa, Khan Muhammad Rafay, Soaib Areeba
Internal Medicine, Jinnah Hospital, Lahore, PAK.
Critical Care Medicine, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR.
Cureus. 2025 Mar 31;17(3):e81521. doi: 10.7759/cureus.81521. eCollection 2025 Mar.
Background Cardiovascular disease is a leading cause of morbidity and mortality worldwide, with a high prevalence in developing countries, and coronary artery disease (CAD) is a major contributor to it. Diabetes mellitus is a major risk factor for CAD. However, research on the association between glycated hemoglobin (HbA1c) levels and severity of CAD is lacking in developing countries like Pakistan. Therefore, this study aimed to investigate the association between HbA1c levels and the severity of CAD in type 2 diabetic patients with myocardial infarction (MI). Method This cross-sectional study was conducted on 225 type 2 diabetic patients with CAD at Cardiology Unit, Jinnah Hospital, Lahore, Pakistan during the period of one year from August 2020 to August 2021. The recruitment of patients was done via consecutive sampling and predefined inclusion and exclusion criteria. Data was collected through a self-devised proforma. The Gensini scoring system was used to determine the CAD severity. Participants were stratified into two groups based on the Gensini score system. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States) via an independent t-test and chi-squared tests, Pearson's correlation coefficient, and linear regression analysis. A p-value < 0.05 was set statistically significant. Results Of 225 patients, 145 patients (64.45%) had non-severe CAD, while 80 patients (35.55%) had severe CAD. Patients with good glycemic control accounted for n=69 (30.66%), while those with poor glycemic control comprised n=156 (69.34%) of the study population. The differences in means with standard deviations (means ± SD) of Gensini scores (p=0.001) and HbA1c levels (p=0.002) between two study groups (patients with severe CAD and non-severe CAD) were statistically significant. A significant positive correlation was found between HbA1c levels and CAD severity (correlation coefficient (r)=0.75, p=0.002). Moreover, linear regression analysis endorsed the HbA1c level as an important predictor of CAD severity, with a beta coefficient (β) of 3.11 and a 95% CI of 1.52-4.60 (p < 0.001). Conclusion This study demonstrates a significant association between HbA1c levels and CAD severity in type 2 diabetic patients with MI. Elevated HbA1c levels are strongly linked to increased CAD severity, highlighting the importance of tight glycemic control in managing CAD in diabetic patients. This study suggests that HbA1c levels can serve as a preliminary marker for early detection of high-risk acute CAD patients, enabling prompt interventions and enhanced clinical outcomes.
背景
心血管疾病是全球发病和死亡的主要原因，在发展中国家患病率很高，冠状动脉疾病（CAD）是其主要促成因素。糖尿病是CAD的主要危险因素。然而，在巴基斯坦等发展中国家，关于糖化血红蛋白（HbA1c）水平与CAD严重程度之间关联的研究尚缺。因此，本研究旨在调查2型糖尿病合并心肌梗死（MI）患者中HbA1c水平与CAD严重程度之间的关联。
方法
本横断面研究于2020年8月至2021年8月期间在巴基斯坦拉合尔真纳医院心脏病科对225例2型糖尿病合并CAD患者进行，为期一年。通过连续抽样和预定义的纳入与排除标准招募患者。数据通过自行设计的表格收集。采用Gensini评分系统确定CAD严重程度。根据Gensini评分系统将参与者分为两组。使用IBM SPSS Statistics for Windows，版本25（2017年发布；IBM公司，美国纽约州阿蒙克）通过独立t检验、卡方检验、Pearson相关系数和线性回归分析进行统计分析。设定p值<0.05具有统计学意义。
结果
在225例患者中，145例患者（64.45%）患有非重度CAD，而80例患者（35.55%）患有重度CAD。血糖控制良好的患者占69例（30.66%），而血糖控制不佳的患者占156例（69.34%）。两个研究组（重度CAD患者和非重度CAD患者）之间Gensini评分（p = 0.001）和HbA1c水平（p = 0.002）的均值与标准差（均值±标准差）差异具有统计学意义。HbA1c水平与CAD严重程度之间存在显著正相关（相关系数（r）= 0.75，p = 0.002）。此外，线性回归分析证实HbA1c水平是CAD严重程度的重要预测指标，β系数为3.11，95%置信区间为1.52 - 4.60（p < 0.001）。
结论
本研究表明2型糖尿病合并MI患者中HbA1c水平与CAD严重程度之间存在显著关联。HbA1c水平升高与CAD严重程度增加密切相关，突出了严格血糖控制在糖尿病患者CAD管理中的重要性。本研究表明HbA1c水平可作为早期检测高危急性CAD患者的初步标志物，有助于及时干预并改善临床结局。
