[Adiponectinemia, inflammatory process activity, and endothelial dysfunction in patients with type 2 diabetes and acute coronary syndrome with ST elevation in relation to the severity of lesions in the coronary arteries].

Introduction: Metabolic disorders developing in diabetes are associated with impaired endothelial function and the presence of subclinical inflammation, in consequence leading to generalized atherosclerosis. Vasoprotective factors include adiponectin, a cytokine with a diverse antiatherosclerotic activity.

Objectives: Evaluation of adiponectin concentrations and activity of the inflammatory process and endothelial dysfunction in patients with type 2 diabetes and acute coronary syndrome (ACS) with ST elevation (STEMI) in relation to the severity of lesions in the coronary arteries.

Patients And Methods: This study included 72 patients (24 women, 48 men) with type 2 diabetes, treated with sulphonylurea derivatives, diagnosed with STEMI, who underwent percutaneous coronary angioplasty. The treated group consisted of 41 patients, mean age (+/- standard deviation) was 64 +/-9.6 years, the Gensini score (GS) >32 points (more advanced lesions in the coronary vessels). The control group consisted of 31 patients, a mean age of 63 +/-10 years, GS <32 points (less advanced lesions). Within 12 hours after the ACS, serum troponin T activity (TnT), creatine kinase MB isoenzyme (CK-MB), C-reactive protein (CRP), fibrinogen, two adhesion molecules - soluble vascular adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesive molecule-1 (sICAM-1) were evaluated in serum of the patients. Leucocytosis, glucose and insulin levels, and lipid profiles were obtained after overnight fast conditions.

Results: Patients in group I demonstrated a significantly higher TnT and CK-MB (1.39 +/-1.3 vs 0.83 +/-0.74 ng/ml, p <0.05; 139.6 +/-178.5 vs 57.48+/-52.1 IU/I p <0.05, respectively), higher concentrations of CRP (12.06 +/-14.3 vs 3.59 +/-4.1mg/l, p <0.05) fibrinogen (4.59 +/-1.93 vs 3.62 +/-1.36 g/l, p <0.05), sVCAM-1 (1393.4 +/-865.4 vs 863.9+/-425.2 ng/ml, p <0.05) and sICAM-1 (735.1+/-316.3 vs 573.3 +/-226.1 ng/ml, p <0.05), higher leucocytosis (11,430 +/-3680 vs 9750+/-3100/microl, p <0.05) and lower adiponectin concentrations (5.8 +/-5.2 vs 8.3 +/-2.9 8 microg/ml, p <0.05) as compared to the control group.

Conclusions: Hypoadiponectinaemia, severity of the inflammatory process and endothelial dysfunction could be factors contributing to the progression of atherosclerotic lesions in the coronary arteries in patients with type 2 diabetes.