Aryamol, M K (2011) Study to analyze the association of cortisol level and prevalence of Coronary Artery Disease in patients with Type 2 Diabetes Mellitus. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
INTRODUCTION : Type 2 diabetes is the predominant form of diabetes worldwide, accounting for 90% of cases globally. An epidemic of Type 2 diabetes is underway in both developed and developing countries. Globally the number of Type 2 DM is expected to rise from the current estimate of 150 to million in 2010 and 300 million in 2025. So Type 2 DM has become one of the world’s most important public health problems. DM both insulin dependent and non-insulin dependent is a risk factor for CAD, accounting for 14%- 50% of new cases of CAD. CAD is the most common cause of death in adults with DM. In diabetes the incidence of CAD relates to the duration of DM, level of glycemic control and its pathogenesis involve endothelial dysfunction and Increased lipoprotein peroxidation, increased inflammation, prothrombotic state and associated metabolic abnormalities. Increased activity of hypothalmopituitary axis and elevated cortisol level may underlie metabolic syndrome and coronary artery disease in patients with Type 2 DM. People with Type 2 DM are at increased risk of cardiovascular disease risk and hyperactive hypothalmopituitary axis thus suitable for study of association of cortisol level with cardiovascular risk. AIM OF STUDY : To analyze the association of Cortisol level and prevalence of coronary artery disease in patients with Type 2 Diabetes Mellitus. DISCUSSION An attempt has been made to study fifty cases of type 2 diabetes mellitus to study the association of cortisol level and coronary artery disease. In the cohort of 50 diabetic patients 23 had coronary artery disease, which comes to 46% of total patients. In the 50 type 2 diabetic patients, 22% had acute coronary syndrome; 24% had ischemic heart disease. The Framingham Heart study revealed a marked increase in congestive heart failure, coronary artery disease and sudden cardiac death in type 2 diabetes mellitus patients(The risk increases from one to five fold in DM).The American Heart association has designated DM as a major risk factor for cardiovascular disease(2). Among 50 DM patients, 52% were males and 48% were females. According to the Centre for Disease Control and Prevention (CDC), the prevalence of DM is similar in men and women throughout most age ranges but is slightly greater in men more than 60 years(2). Conventional risk factors for coronary artery disease are diabetes mellitus, systemic hypertension, dyslipedemia, etc. Diabetes mellitus is the major risk factor for coronary artery disease. Newly proposed theory is that there is an overactivity of hypothalamopituitary adrenal axis and elevated cortisol level(19). Elevated cortisol is a single risk factor for coronary artery disease. According to Edinburg type 2 diabetes study, type 2 diabetic patients have hyperactive hypothalamopituitary adrenal axis and have elevated cortisol level and it was concluded that there is an increased chance of metabolic syndrome and coronary artery disease in patients with elevated cortisol level. Out of 50 diabetic patients, 10 patients had elevated cortisol level.8 out of 10 patients with elevated level had coronary artery disease. This shows that there is an association between elevated cortisol level and coronary artery disease(19). In our population, cortisol is only moderately elevated. Also, cortisol is elevated in patients who are having more than one complication of diabetes like dyslipedemia, central obesity, proteinuria and hypertension. Also, there is an association between elevated cortisol and coronary artery disease. The study was conducted at Coimbatore Medical Hospital, Coimbatore during period of September 2009 to September 2010. 50 patients of Type 2DM were included in the study. No patients had been counted if he/she got admitted again after discharge during this period. MATERIALS &METHODS : Design of study: Cross sectional study. Methodology: 50 Type 2DM patients who got admitted in Coimbatore Medical College, Hospital were included in the study. 50 consecutive were recorded. In those patients BP, Waist Circumference, Blood Glucose Levels, Lipid profile, fasting cortisol level and Urine Protein were measured and ECG, Echocardiogram was taken to study whether there is an increased association of cortisol level with prevalence of coronary artery disease in patients with Type 2DM. Inclusion Criteria: 1. Type 2 DM Patients, 2. Age group above 50 years, 3. Both Sexes, 4. First Admission. Exclusion Criteria: 1. Cushing disease / Syndrome, 2. Patients who are on steroid treatment, 3. Age group below 50 years. CONCLUSION : There is hyperactivity of hypothalamopituitary axis in type 2 DM patients. Out of 50 patients,10 had mild to moderate elevation of fasting serum Cortisol. There is an association of elevated cortisol and high prevalence of coronary artery disease in patients with type 2 DM. Further studies are needed to find out the mechanism of hypothalamopituitary axis overactivity. Further studies are needed to find out the pathogenesis behind elevated cortisol causing coronary artery disease.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | cortisol level ; prevalence ; Coronary Artery Disease ; patients ; Type 2 Diabetes Mellitus. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Feb 2018 20:32 |
| Last Modified: | 17 Feb 2018 20:32 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5849 |
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