The importance of atherosclerotic lesions of the coronary arteries in the development of cardiac arrhythmias in ischemic heart disease in patients with type 2 diabetes mellitus

Aim. To analyze the relationship between coronary artery damage and the development of changes in cardiac rhythm and conductivity in patients with chronic coronary heart disease and type 2 diabetes mellitus.

Material and methods. A cross-sectional retrospective observational study was conducted among 222 patients with diagnosed coronary artery disease, the patients were divided into 2 groups: 126 patients with coronary artery disease and type 2 diabetes and 96 patients with coronary artery disease without carbohydrate metabolism disorders. Statistical processing was performed using IBM SPSS Statistics Version 25.0, nonparametric statistical methods were used.

Results. In patients of the main group, there was a more frequent association of right coronary artery lesions with the presence of atrioventricular block (p = 0,021) and right bundle branch block (p = 0,019).

Conclusion. The analysis demonstrated that in patients with coronary heart disease in combination with type 2 diabetes, coronary artery disease is an important link in the pathogenetic chain of cardiac arrhythmias and conduction disorders. The results obtained emphasize the need to use comprehensive methods to assess the risk of arrhythmias in patients with various clinical variants of coronary heart disease, especially in the presence of concomitant metabolic disorders such as type 2 diabetes mellitus.

1. Russian Society of Cardiology. Clinical guidelines "Stable ischemic heart disease". 2024.

2. Boytsov S.A., Barbarash O.L., Vaisman D.Sh., et al. Clinical, morphological and statistical classification of ischemic heart disease: Consensus of the Russian Society of Cardiology, Russian Society of Pathologists and Medical Statisticians. 2020. 24 p. URL: https://scardio.ru/content/Guidelines/Klass_IBS_2020.pdf (date of access: 05/24/2024).

3. Dedov I.I., Shestakova M.V., Mayorov A.Yu., et al. Algorithms of specialized medical care for patients with diabetes mellitus. Edited by I.I. Dedov, M.V. Shestakova, A.Yu. Mayorov. 10th edition. Diabetes mellitus. 2021. Vol. 24, No. 1S. P. 1-148. DOI: 10.14341/DM12802.

4. International Diabetes Federation. IDF Diabetes Atlas. 10th edition, 2024. URL: https://diabetesatlas.org/

5. Shi W., Zhang W., Zhang D., et al. Comparison of the effect of glucose-lowering agents on the risk of atrial fibrillation: A network meta-analysis. Heart Rhythm. 2021; 18 (7): 1090-1096. DOI: 10.1016/j.hrthm.2021.03.007.

6. Alexandrov A.A., Yadrikhinskaya M.N., Kukharenko S.S. Atrial fibrillation: the new face of diabetes mellitus in the XXI century. Diabetes mellitus. 2011; 14 (1):53-60. DOI:10.14341/2072-0351-6250.

7. Alexander B., Tse G., Martinez-Selles M., et al. Atrial conduction disorders. current cardiology reviews. 2021; 17 (1): 68-73. PMID: 33438553; PMCID: PMC8142376. DOI: 10.2174/1573403X17666210112161524.

8. Tancredi M., Rosengren A., Svensson A.M., et al. Excess mortality among persons with type 2 diabetes. The new england journal of medicine. 2015; 373 (18): 1720-32. PMID: 26510021. DOI: 10.1056/NEJMoa1504347.5. Coronary angiography and stenting: a guide. Edited by Chernyavsky A.M. Moscow: GEOTAR-Media, 2022. 328 p.

9. Xu W., Li X., Liu T., et al. Control for multiple risk factors and incident heart failure and mortality in patients with diabetes mellitus: Insights from the Kailuan cohort study. Current Problems in Cardiology. 2024; 49 (9): 102737. Epub 2024 Jun 27. PMID: 38944222. DOI: 10.1016/j.cpcardiol.2024.102737.

10. Coronary angiography and stenting: a guide. Edited by Chernyavsky A.M. Moscow: GEOTAR-Media, 2022. 328 p.

11. Rawshani A., McGuire D.K., Omerovic E., et al. Cardiac arrhythmias and conduction abnormalities in patients with type 2 diabetes. Sci Rep. 2023. Jan 21; 13 (1): 1192. PMID: 36681691. DOI: 10.1038/s41598-023-27941-5.

12. Ushanova F.O., Izmailova M.Ya., Nadybina M.N. Cardiac arrhythmias in patients with type 2 diabetes mellitus. FOCUS. Endocrinology. 2024. № 2. URL: https://cyberleninka.ru/article/n/narusheniya-serdechnogo-ritma-u-patsientov-s-saharnym-diabetom-2-tipa.

13. Morgunov L.Y. Diabetes mellitus and cardiac arrhythmias. The Attending Physician. 2024; 3 (27): 7-15. DOI:10.51793/OS.2024.27.3.001.

14. Kralev S., Schneider K., Lang S., et al. Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography. PLoS One. 2011; 6 (9): 24964. Epub 2011 Sep 21. PMID: 21957469. PMCID: PMC3177852. DOI: 10.1371/journal.pone.0024964.

15. Rinchinova T.S., Serebryakova O.V., Fedorova A.P., et al. Associations of paraoxanase 1 gene polymorphism with coronary artery disease in patients with chronic coronary artery disease and type 2 diabetes mellitus. Bulletin of the therapist. 2024. № 2 (63).URL: https://journaltherapy.ru/statyi/associacii-polimorfizma-gena-paraoksanazy-1-s-porazheniem-koronarnogo-rusla-u-bolnyh-hronicheskoj-ishemicheskoj-boleznju-serdca-i-saharnym-diabetom-2-go-tipa. DOI: 10.31550/2712-8601-VT-2024-2-1.

16. Nurgalieva G.K., Urazalina S.Zh., Zhaisanbai A.I., Dosmailova L.K. The state of the coronary bed in patients with coronary heart disease against the background of diabetes mellitus. Bulletin of KazNMU. 2020; 2: 108–14.