Original investigation

Relevance of hemostatic risk factors on coronary morphology in patients with diabetes mellitus type 2

Thomas W Jax^1,2,3 , Ansgar J Peters³ , Gunnar Plehn⁴ and Frank-Chris Schoebel³

¹  Profil Institut für Stoffwechselforschung, Division of Cardiometabolic Research, Hellersbergstrasse 9, 41460 Neuss, Germany

²  Klinik für Kardiologie, Herzzentrum Wuppertal, Universität Witten-Herdecke, Wuppertal, Germany

³  Medizinische Klinik und Poliklinik B (Internal Medicine), Department of Cardiology, Pneumology and Angiology, Heinrich-Heine-University, Düsseldorf, Germany

⁴  Klinik für Kardiologie, Marienhospital Herne, Herne, Germany

author email corresponding author email

Cardiovascular Diabetology 2009, 8:24doi:10.1186/1475-2840-8-24

Published:	6 May 2009

Abstract

Objective

The influence hemostatitc parameters on the morphological extent and severity of coronary artery disease were studied in patients with and without DM type 2.

Background

It is known that patients with diabetes (DM) have abnormal metabolic and hemostatic parameters

Methods

Of 150 consecutive patients with angiographically proven coronary artery disease 29 presented with DM. Additionally to parameters of lipid-metabolism fibrinogen, tissue-plasminogenactivator (t-PA), plasminogen-activator-inhibitor (PAI), plasmin-a-antiplasmin (PAP), prothrombin-fragment 1+2 (F1+2), thrombin-antithrombin (TAT), von-willebrand-factor (vWF), platelet factor 4 (PF4), glykomembranproteine 140 (GMP140) and the rheologic parameters plasma viscosity and red blood cell aggregation were evaluated. The extent and severity of CAD was evaluated according to the criteria of the American Heart Association.

Results

Patients with DM presented with a higher number of conventional risk factors as compared to non-diabetic patients. Additionally there were significant differences for F1+2, red blood cell aggregation and PAI. Diabetic patients showed a more severe extent of coronary arteriosclerosis, which also could be found more distally. A significant relationship between blood-glucose, thrombocyte-activation (vWF), endogenous fibrinolysis (PAI) and the severity of CAD and a more distal location of stenoses could be found (r = 0.6, p < 0.001).

Conclusion

Patients with coronary artery disease and DM type 2 showed marked alterations of metabolic, hemostatic, fibrinolytic and rheologic parameters, which can produce a prothrombogenic state. A direct association of thrombogenic factors on coronary morphology could be shown. This can be the pathophysiologic mechanism of more severe and distal pronounced coronary atherosclerosis in these patients.