EVALUATION OF THE RELATIONSHIP BETWEEN MPV AND SEVERITY OF CORONARY ARTERY DISEASE IN TYPE 2 DIABETIC PATIENTS WITHOUT ACUTE CORONARY SYNDROME

Abstract

Objective Since many studies focused on the relationship between mean platelet volume (MPV) and severity of type 2 diabetes mellitus (T2DM) or investigated MPV and coronary artery disease (CAD) mostly on acute coronary syndrome (ACS), this study primarily focused to investigate if MPV values have any relation with different levels of CAD specifically in T2DM patients, who had no previous coronary artery disease, and no ACS history. Materials And Methods T2DM patients who had first coronary angiography (CAG) between November 2019 and February 2020, and whose after night fasting blood tests were performed before CAG were included. Two cardiologists, blinded to the patients, evaluated angiographies. Patients have divided into groups accordingly; normal coronary artery (Group 1), non-critic stenosis (Group II), and severe CAD (Group III) according to the Gensini score. Patients’ demographics, heart rate, risk factors of CAD, and blood test including MPV were also collected. Results A total of 180 patients (88 female, 92 male) were involved in the study. There was no significant relation between MPV and the severity of CAD in T2DM patients (p=0.228). The mean age of the Group I group was significantly lower than in other groups (p=0.228), and there were significantly lower males in Group I than other groups (p=0.0001). The triglycerides levels were significantly low in Group I than in other groups (p=0.021 and p=0.006). Conclusion MPV values were not associated with the severity of CAD in stable patients. Older age, male gender, higher levels of triglycerides, and initial glucose levels were significantly related to the severity of CAD in T2DM patients.

Keywords

• Coronary artery disease
• mean platelet volume
• type 2 diabetes mellitus

AKUT KORONER SENDROM OLMAYAN TİP 2 DİYABETİK HASTALARDA KORONER ARTER HASTALIĞI YAYGINLIĞI İLE MPV İLİŞKİSİNİN ARAŞTIRILMASI

Abstract

Amaç Birçok çalışma, ortalama trombosit hacmi (MPV) ile tip 2 diabetes mellitus (T2DM) şiddeti arasındaki ilişkiye odaklanmakta veya MPV ve koroner arter hastalığı (KAH) çoğunlukla akut koroner sendrom (AKS) hastaları üzerinde gerçekleştirilmektedir. Bu çalışma öncelikle koroner arter hastalığı ve AKS öyküsü olmayan T2DM hastalarında MPV değerlerinin farklı derecelerdeki KAH ile ilişkisi araştırılmıştır. Gereç ve Yöntem Kasım 2019 ile Şubat 2020 tarihleri arasında ilk koroner anjiyografi (CAG) yaptıran ve CAG öncesi gece açlık kan testleri yapılan T2DM hastaları dahil edildi. Anjiyografiler iki kardiyolog değerlendirdi. Hastalar bu bulgular ve Gensini skoruna göre; normal koroner arter (Grup 1), kritik olmayan darlık (Grup II) ve ciddi KAH (Grup III) olarak 3 gruba ayrıldı. Hastaların demografik verileri, kalp atış hızı, CAD risk faktörleri ve MPV dahil kan testleri değerlendirildi. Bulgular Çalışmaya toplam 180 hasta (88 kadın, 92 erkek) dahil edildi. T2DM hastalarında MPV ile KAH şiddeti arasında anlamlı bir ilişki bulunmadı (p=0,228). Grup I grubunun ortalama yaşı diğer gruplardan anlamlı olarak daha düşüktü (p=0,228). Grup I'de diğer gruplara göre anlamlı oranda düşük sayıda erkek vardı (p=0,0001). Trigliserid düzeyleri Grup I'de diğer gruplara göre anlamlı olarak düşüktü (p=0,021 ve p=0,006). Sonuç MPV değerleri stabil hastalarda KAH şiddeti ile ilişkili bulunmadı. T2DM hastalarında ileri yaş, erkek cinsiyet, yüksek trigliserit seviyeleri ve başlangıç glikoz seviyeleri, KAH şiddeti ile önemli ölçüde ilişkiliydi.

Keywords

• Koroner arter hastalığı
• ortalama trombosit hacmi
• tip 2 diabetes mellitus

References

1. 1. Emerging Risk Factors C, Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215-22.
2. 2. Lorber D. Importance of cardiovascular disease risk management in patients with type 2 diabetes mellitus. Diabetes Metab Syndr Obes. 2014;7:169-83.
3. 3. Demirtunc R, Duman D, Basar M, Bilgi M, Teomete M, Garip T. The relationship between glycemic control and platelet activity in type 2 diabetes mellitus. J Diabetes Complications. 2009;23(2):89-94.
4. 4. Zuberi BF, Akhtar N, Afsar S. Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucose and non-diabetic subjects. Singapore Med J. 2008;49(2):114-6.
5. 5. Budzianowski J, Pieszko K, Burchardt P, Rzezniczak J, Hiczkiewicz J. The Role of Hematological Indices in Patients with Acute Coronary Syndrome. Dis Markers. 2017;2017:3041565.
6. 6. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17(1):47-58.
7. 7. Estevez-Loureiro R, Salgado-Fernandez J, Marzoa-Rivas R, Barge-Caballero E, Perez-Perez A, Noriega-Concepcion V, et al. Mean platelet volume predicts patency of the infarct-related artery before mechanical reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Thromb Res. 2009;124(5):536-40.
8. 8. Lopez-Cuenca AA, Tello-Montoliu A, Roldan V, Perez-Berbel P, Valdes M, Marin F. Prognostic value of mean platelet volume in patients with non-ST-elevation acute coronary syndrome. Angiology. 2012;63(4):241-4.

9. 9. Dogan A, Aksoy F, Icli A, Arslan A, Varol E, Uysal BA, et al. Mean platelet volume is associated with culprit lesion severity and cardiac events in acute coronary syndromes without ST elevation. Blood Coagul Fibrinolysis. 2012;23(4):324-30.
10. 10. Nardin M, Verdoia M, Barbieri L, De Luca G, Novara Atherosclerosis Study G. Impact of metabolic syndrome on mean platelet volume and its relationship with coronary artery disease. Platelets. 2019;30(5):615-23.
11. 11. Jindal S, Gupta S, Gupta R, Kakkar A, Singh HV, Gupta K, et al. Platelet indices in diabetes mellitus: indicators of diabetic microvascular complications. Hematology. 2011;16(2):86-9.
12. 12. Hekimsoy Z, Payzin B, Ornek T, Kandogan G. Mean platelet volume in Type 2 diabetic patients. J Diabetes Complications. 2004;18(3):173-6.
13. 13. Zaccardi F, Rocca B, Pitocco D, Tanese L, Rizzi A, Ghirlanda G. Platelet mean volume, distribution width, and count in type 2 diabetes, impaired fasting glucose, and metabolic syndrome: a meta-analysis. Diabetes Metab Res Rev. 2015;31(4):402-10.
14. 14. Shah B, Sha D, Xie D, Mohler ER, 3rd, Berger JS. The relationship between diabetes, metabolic syndrome, and platelet activity as measured by mean platelet volume: the National Health And Nutrition Examination Survey, 1999-2004. Diabetes Care. 2012;35(5):1074-8.
15. 15. Verdoia M, Schaffer A, Barbieri L, Cassetti E, Nardin M, Bellomo G, et al. Diabetes, glucose control and mean platelet volume: a single-centre cohort study. Diabetes Res Clin Pract. 2014;104(2):288-94.
16. 16. Hudzik B, Szkodzinski J, Lekston A, Gierlotka M, Polonski L, Gasior M. Mean platelet volume-to-lymphocyte ratio: a novel marker of poor short- and long-term prognosis in patients with diabetes mellitus and acute myocardial infarction. J Diabetes Complications. 2016;30(6):1097-102.
17. 17. GENSINI C. Coronary arteriography. Heart disease. 1980.
18. 18. Olafsdottir E, Andersson DK, Dedorsson I, Stefansson E. The prevalence of retinopathy in subjects with and without type 2 diabetes mellitus. Acta Ophthalmol. 2014;92(2):133-7.
19. 19. Wang J, Zhang L, Wang F, Liu L, Wang H, China National Survey of Chronic Kidney Disease Working G. Prevalence, awareness, treatment, and control of hypertension in China: results from a national survey. Am J Hypertens. 2014;27(11):1355-61.
20. 20. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2(5):358-67.
21. 21. Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. J Cell Physiol. 2019;234(10):16812-23.
22. 22. Kodiatte TA, Manikyam UK, Rao SB, Jagadish TM, Reddy M, Lingaiah HK, et al. Mean platelet volume in Type 2 diabetes mellitus. J Lab Physicians. 2012;4(1):5-9.
23. 23. Demirin H, Ozhan H, Ucgun T, Celer A, Bulur S, Cil H, et al. Normal range of mean platelet volume in healthy subjects: Insight from a large epidemiologic study. Thromb Res. 2011;128(4):358-60.
24. 24. Tufano A, Cimino E, Di Minno MN, Ierano P, Marrone E, Strazzullo A, et al. Diabetes mellitus and cardiovascular prevention: the role and the limitations of currently available antiplatelet drugs. Int J Vasc Med. 2011;2011:250518.
25. 25. Sansanayudh N, Anothaisintawee T, Muntham D, McEvoy M, Attia J, Thakkinstian A. Mean platelet volume and coronary artery disease: a systematic review and meta-analysis. Int J Cardiol. 2014;175(3):433-40.
26. 26. Akin F, Ayca B, Kose N, Altun I, Avsar M, Celik O, et al. Relation of platelet indices to severity of coronary artery disease in patients undergoing primary percutaneous coronary intervention. Perfusion. 2016;31(3):216-22.
27. 27. Borekci A, Gur M, Turkoglu C, Selek S, Baykan AO, Seker T, et al. Oxidative Stress and Spontaneous Reperfusion of Infarct-Related Artery in Patients With ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost. 2016;22(2):171-7.
28. 28. Choi DH, Kang SH, Song H. Mean platelet volume: a potential biomarker of the risk and prognosis of heart disease. Korean J Intern Med. 2016;31(6):1009-17.
29. 29. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1(2):219-27.
30. 30. XU W-l, XU L, WANG X, SHAO Y-b. Mean platelet volume and its influenced factors in acute coronary syndrome. South China Journal of Cardiovascular Diseases. 2012(1):10.
31. 31. Vogiatzis I, Samaras A, Grigoriadis S, Sdogkos E, Koutsampasopoulos K, Bostanitis I. The Mean Platelet Volume in the Prognosis of Coronary Artery Disease Severity and Risk Stratification of Acute Coronary Syndromes. Med Arch. 2019;73(2):76-80.
32. 32. Ulutas KT, Dokuyucu R, Sefil F, Yengil E, Sumbul AT, Rizaoglu H, et al. Evaluation of mean platelet volume in patients with type 2 diabetes mellitus and blood glucose regulation: a marker for atherosclerosis? Int J Clin Exp Med. 2014;7(4):955-61.
33. 33. Sayın MR, Çetiner MA, Karabağ T, Doğan SM, Aydın M, Yavuz N. Koroner Arter Hastalığında Gensini Skoru ve Tam Kan Sayımı Parametreleri Arasındaki İlişki. Koşuyolu Kalp Dergisi.15(2):51-4.
34. 34. Ekici B, Erkan AF, Alhan A, Sayin I, Ayli M, Tore HF. Is mean platelet volume associated with the angiographic severity of coronary artery disease? Kardiol Pol. 2013;71(8):832-8.
35. 35. McKarns SC, Smith CJ, Payne VM, Doolittle DJ. Blood parameters associated with atherogenic and thrombogenic risk in smokers and nonsmokers with similar life-styles. Mod Pathol. 1995;8(4):434-40.
36. 36. Austin MA, Hokanson JE, Edwards KL. Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol. 1998;81(4A):7B-12B.