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Socioeconomic and clinical determinants of coronary artery disease in symptom-free type 2 diabetes mellitus patients
Chikezie Hart Onwukwe1, Nkiru Ifeoma Chikezie2, Kalu Kalu Okorie3, Eric Okechukwu Umeh4, Chukwunonso Celestine Odenigbo5, Charles Ukachukwu Osuji6, Augustine Efedaye Ohwovoriole7
1 Department of Health Affairs, Al Isawiya General Hospital, Al Qurayyat Governorate, Qurayyat, Kingdom of Saudi Arabia
2 Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
3 Department of Internal Medicine, Garki Hospital, Garki, Abuja, Nigeria
4 Department of Radiology, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Anambra, Nigeria
5 Department of Internal Medicine, Medical College of Wisconsin, Madison, Wisconsin, USA
6 Department of Internal Medicine, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Anambra, Nigeria
7 Department of Internal Medicine, College of Medicine and Health Sciences, Bingham University, Jos Campus, Jos, Nigeria
Correspondence Address:
Chikezie Hart Onwukwe,
Department of Health Affairs, Al Isawiya General Hospital, Al Qurayyat Governorate, Qurayyat
Kingdom of Saudi Arabia
 Source of Support: None, Conflict of Interest: None
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Background: There are global reports of rising cardiovascular burden in persons living with type 2 diabetes mellitus (T2DM) patients. The presence of coronary artery disease (CAD) increases mortality risk in T2DM patients. There are currently no data on the determinants of CAD in Nigerian T2DM patients. Objective: The objective was to determine the determinants of CAD in persons with T2DM. Methods: This was a cross-sectional study involving T2DM patients with and without CAD attending the diabetes clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. The diagnosis of CAD was made based on personal information obtained using the Rose angina questionnaire and resting electrocardiogram findings. Medical history and other clinical evaluations were done to identify the socioeconomic and clinical variables in the study participants. Data obtained were analyzed using appropriate statistical software. Results: The study involved 400 asymptomatic T2DM patients with a median age of 60 years and a female-to-male ratio of 1.3:1. Sixty-four (16%) participants had CAD. The male: female ratio in CAD and non-CAD groups was 1.8:1 and 0.7:1 (χ2 = 1.7, P = 0.22). Formal education (χ2 = 4.1, P = 0.02), upper socioeconomic class (χ2 = 5.1, P = 0.02), hypertension (χ2 = 2.2, P = 0.03), dyslipidemia (χ2 = 4.7, P = 0.02), cerebrovascular disease (χ2 = 5.2, P = 0.01), smoking (χ2 = 9.1, P = 0.01), waist circumference (Mann–Whitney U = 358, P = 0.02), carotid intima-media thickness (Mann–Whitney U = 300, P = 0.01), and ankle brachial pressure index (Mann–Whitney U = 315, P = 0.01) were significantly associated with CAD in the study participants. Multivariate logistic regression analysis showed that formal education had the least odds of predicting CAD (odd ratio [OR] =2.1, 95% confidence interval [CI] =1.6–6.2; P = 0.02), while low-density lipoprotein cholesterol had the highest odds of predicting CAD (OR = 5.2, 95% CI = 2.1–9.5, P = 0.01) among the study participants. Conclusions: Early screening for comorbidities and lipid abnormalities in T2DM patients is required, especially in those with formal education and within the high socioeconomic class.
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