Alteraciones electrocardiográficas y factores de riesgo cardiovascular en pacientes con diabetes tipo 2

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Abstract

Objetivo. Determinar cuáles son las alteraciones del ritmo y la conducción cardiaca más frecuentes en pacientes con diabetes tipo 2 sin cardiopatía previa y establecer su asociación con los factores de riesgo cardiovascular. Material y métodos. Se incluyeron pacientes con diabetes tipo 2 sin presencia o antecedentes de cardiopatía. Se determinaron los factores de riesgo cardiovascular, el índice de masa corporal y los niveles séricos de glucosa, colesterol y triglicéridos. Se registró electrocardiograma convencional en reposo. La asociación de las variables en estudio con la ocurrencia de arritmias se calculó con un modelo de análisis multivariado ajustado por sexo. Resultados. Se integraron 199 pacientes: 113 mujeres (56.8%) y 86 hombres (43.2%), y se identificó algún tipo de alteración electrocardiográfica en 29.1% de los sujetos. El hemibloqueo fascicular anterior (HFA) y el bloqueo completo de rama derecha del Haz de His (BRDHH), constituyeron 75.9% de las alteraciones identificadas. Los pacientes con trastornos del ritmo y la conducción tienen niveles más elevados de colesterol y triglicéridos. La aparición de arritmias se relaciona directamente con el incremento de la edad (r= 0.75, p= 0.01). En el análisis multivariado ajustado por sexo la hipercolesterolemia y la edad se asociaron significativamente con las alteraciones del ritmo y la conducción: RM 1.5, IC95% 1.1-4.6, p< 0.05 y RM 1.3, IC95% 1.0-5.2, p< 0.05, respectivamente. Conclusiones. Las alteraciones del ritmo y la conducción cardiaca más frecuentes en la diabetes tipo 2 son el HFA y el BRDHH; la hipercolesterolemia y la edad son los factores asociados a su presencia.

Translated abstract

Objective. To determine the most frequent alterations in rhythm and cardiac conduction in patients with type 2 diabetes without previous cardiopathy, and to establish the association of this disease with cardiovascular risk factors. Material and methods. Subjects with type 2 diabetes, without cardiopathy antecedents were included in the study. Cardiovascular risk factors, body mass index and serum glucose, cholesterol and trygliceride levels were determined. A resting electrocardiogram was recorded. The association between the variables under study and arrhythmia was calculated with a multivariate analysis adjusted by sex. Results. A total of 199 patients were included: 113 women (56.8%) and 86 men (43.2%). Arrhythmia was registered in 29.1% of the subjects. Anterior hemiblock (AH) and right bundle branch block (RBBB) constituted 75.9% of the identified alterations. Patients with arrhythmia and conduction disorders have higher levels of cholesterol and triglycerides. Appearance of arrhythmia is directly related to aging (r= 0.75, p= 0.01). The multivariate analysis adjusted by sex revealed that hypercholesterolemia and aging are significantly associated with arrhythmia and conduction alterations: OR 1.5, CI 95%, 1.1-4.6, p< 0.05 and OR 1.3, CI 95% 1.0-5.2, p< 0.05, respectively. Conclusions. The most frequent arrhythmia and conduction disorders in type 2 diabetes are AH and RBBB. Hypercholesterolemia and aging are the strongest and most frequent factors associated to the presence of this disease.

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Most cited references 21

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Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial.

(1995)

The Diabetes Control and Complications Trial (DCCT), a multicenter, randomized, controlled clinical trial, demonstrated that intensive diabetes therapy delays the onset and slows the progression of retinopathy, nephropathy, and neuropathy in patients with insulin-dependent diabetes mellitus. This study presents the effect of intensive therapy on atherosclerosis-related events and associated risk factors. Patients (n = 1,441) between the ages of 13 and 39 years with insulin-dependent diabetes mellitus were randomly assigned to conventional or intensive diabetes treatment. The patients were free of cardiovascular disease at baseline. Patients with hypertension, hypercholesterolemia, or obesity were excluded. Average length of follow-up was 6.5 years (range 3.5 to 9). The study used standardized definitions of macrovascular events, verification of such events, and central laboratories for determination of lipids and the grading of electrocardiograms. The number of combined major macrovascular events was almost twice as high in the conventionally treated group (40 events) as in the intensive-treatment group (23 events), although the differences were not statistically significant (p = 0.08). There were no differences in the cumulative incidence of hypertension. Mean total serum cholesterol, calculated low-density lipoprotein cholesterol, and triglycerides were significantly reduced in the intensive-treatment group (p 160 mg/dl. Weight gain was significantly increased in the intensive-treatment group (p < 0.001). There were no differences in cigarette smoking habits, consumption of alcohol, or aspirin use between treatment groups. The reduction in some, but not all, cardiovascular risk factors suggests a potential beneficial effect of intensive therapy on macrovascular disease in insulin-dependent diabetes mellitus.

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Echocardiographic evidence for the existence of a distinct diabetic cardiomyopathy (the Framingham Heart Study).

Maurizio Galderisi, Keaven Anderson, Peter Wilson … (1991)

Although several reports have described early changes of cardiac structure and function in diabetic patients, controversy persists regarding the existence of a clinically distinct diabetic cardiomyopathy. To this end, sex-specific linear regression analyses were used to examine the contribution of diabetes mellitus and glucose intolerance to age-adjusted echocardiographic parameters in 1,986 men (mean age 48 years) and 2,529 women (mean age 50 years) from the original Framingham Study cohort and the Framingham Offspring Study. Subjects with evidence of cardiovascular disease at the time of echocardiogram were excluded. Diabetics had higher heart rates than nondiabetics (67.9 vs 64.0 beats/min (p = 0.002) in men, and 73.1 vs 68.3 beats/min (p = 0.004) in women). Diabetic women had increased left ventricular (LV) wall thickness (18.7 vs 17.1 mm, p less than 0.001), relative wall thickness (0.403 vs 0.377, p = 0.008), LV end-diastolic dimension (46.9 vs 45.7 mm, p = 0.03) and LV mass corrected for height (100.4 vs 82.2 g/m, p less than 0.001). Women with glucose intolerance showed similar, less significant trends (p = 0.007 for wall thickness, p less than 0.01 for LV mass). In diabetic men, fractional shortening was slightly reduced (0.355 vs 0.360, p less than 0.05). In a multivariate model that included potentially confounding factors, diabetes remained an independent contributor to LV mass (p = 0.004) and wall thickness (p = 0.008) in women. In a separate linear regression model, which assessed the association of age with LV mass, the age-coefficient for diabetic women was much higher than that for nondiabetics (13.6 vs 6.6 g/m per 10-year increment in age).(ABSTRACT TRUNCATED AT 250 WORDS)