Caratterizzazione clinica, metabolica e infiammatoria di una popolazione di coronaropatici senza apparenti disturbi del metabolismo glicidico: studio MIDIAB

Objective: patients with a previous Myocardial Infarction (MI) and Type 2 diabetes (DM) have the highest risk for cardiovascular mortality, but T2DM is often undiagnosed. We tried to identify which among inflammatory and metabolic markers is the best predictor of T2DM in our population. Methods and Results: glucose tolerance status in patients with a previous MI and no diagnosis of diabetes was correlated to severity of coronary artery disease and pro- and anti-inflammatory markers (high sensitivity C-Reactive Protein, TNF-alfa, Adiponectin). In non diabetic CAD patients, upon OGTT, we observed that 20% of the patients were affected by T2DM, 37% by impaired glucose tolerance (IGT), and only the 43% were really normoglycemic (NGT). The number of disease affected vessels was correlated to 2h-post load glucose value (Spearman’s ñ=0.3, p<0.01). Interestingly, we found that while at univariate analysis the 2h-post load glucose level was positively correlated with TNF-alfa (r =0.257, p<0.01) and inversely with Adiponectin (r =-203, p<0.05), the multivariate analysis showed that only Adiponectin was an independent predictor of defects in glucose tolerance in CAD patients. Treatment of CAD/IGT patients (n=13) with Pioglitazone for 12 weeks determined an increase in Adiponectin associated to an improved endothelial function and insulin sensitivity. Conclusions: Our study shows that adiponectin is decreased in CAD patients with undiagnosed impaired glucose metabolism independently from other risk factors for altered glucose tolerance, suggesting a potential role for Adiponectin/TNF-alfa axis in impairing glucose tolerance in patients with severe coronary atherosclerosis