Ischemic heart disease, the leading global cause of death with 9.1 million fatalities in 2021, disproportionately affects patients with diabetes, amplifying the need to identify modifiable risk factors.[1] The study by Viruthagiri et al.[2] published in this issue of the International Journal of the Cardiovascular Academy, provides robust evidence linking glycemic control to the anatomical severity of coronary artery disease (CAD) in a diabetic cohort. The authors conducted a prospective observational study of 121 diabetic patients with angiographically confirmed CAD at SRM Medical College Hospital in India. The study utilized the SYNTAX score II (SSII)—which stratifies disease complexity into low (<22), intermediate (23-32), and high (≥33) risk categories—to determine the relationship between metabolic parameters and coronary complexity.[2]
The Aggressive Link: Glycated Hemoglobin (HbA1c) and High-risk CAD
The findings confirm that poor metabolic control correlates directly with advanced coronary disease. Patients exhibited a high mean HbA1c level (8.53±1.68%), which significantly predicted severe CAD (P = 0.040). Crucially, each 1% increase in HbA1c raised the odds of belonging to the high-risk SSII group by 62.9% [odds ratio (OR) =1.62, P = 0.014].
This relationship is not isolated; the analysis underscores a pervasive cardiorenal-metabolic interplay. Longer diabetes duration (OR =1.13, P = 0.049); reduced left ventricular ejection fraction (LVEF) (OR =0.0004, P = 0.019); and declining creatinine clearance (OR =0.96, P = 0.001) were also identified as independent predictors of worsening SSII (Table 1). These results strongly align with global evidence linking chronic hyperglycemia to accelerated atherosclerosis via endothelial dysfunction and inflammation.[3]
Therapeutic Mandate
The utility of the SSII in risk stratification supports its vital role in guiding revascularization decisions (percutaneous coronary intervention vs. coronary bypass grafting). The study compellingly highlights HbA1c as a critical therapeutic target; achieving and maintaining tight glycemic control is essential to mitigate the progression of complex coronary anatomy. Furthermore, the strong associations involving LVEF and creatinine clearance support integrated cardiorenal management to address the systemic nature of the disease in patients with diabetes.
While limitations such as the single-center design and the exclusion of well-controlled diabetics restrict the generalizability of the findings, the conclusions offer valuable insights for clinicians. This study underscores the need for multicenter trials to refine personalized strategies for patients with diabetes, ultimately aiming to reduce the global burden of advanced CAD.
