Introduction / Background
Diabetes Mellitus (DM) is a clinical syndrome characterized by absolute or relative deficiency of Insulin. Lack of insulin affects the metabolism of carbohydrates, proteins and fat and causes a significant disturbance of water and electrolytes homeostasis and so profound effects on cardiovascular system1. Diabetes is world-wide in distribution and the incidence of both type 1 and 2 is rising. It is estimated that in the year 2000,150 million people world-wide had diabetes and this is expected to double by 2010, 1. Ischaemic heart disease (IHD) is a syndrome which remains a major cause of death world-wide. It includes Angina Pectoris, Acute Myocardial Infarction and sudden cardiac death. As per WHO Report 55/100000 of American die of IHD and 45.3% of all deaths in USA are due to IHD 2. The major risk factors that predispose to atherosclerosis and IHD have been identified by means of number of prospective studies in well established population groups 3-5. Ischaemic heart disease accounts for higher mortality in type 2 DM 6. In the UK prospective diabetes study after 9 years of follow up, IHD events were 70 times more frequent than other diabetic complications. The annual average mortality rate is double than that in non diabetic people 7. Many studies have been conducted at international level to analyze risk factors in developing IHD in diabetic population 3-6 and there are also few studies at national level 8-9. My study is designed to investigate the presence of risk factors in type 2 diabetic population i.e. dyslipidemia, hypertension and smoking to analyze their significance as risk factors in development of IHD among diabetics.
The objective of this study is to; determine presence of dyslipidemia, hypertension and smoking among diabetics with IHD as compared to those who do not develop IHD in patients presenting at department of medicine Holy Family Hospital.
Material and Methods
Cardiovascular risk factors in Type2 diabetic patients developing IHD are statistically significant.
Study Design : Cross-Section Study
Sample Size : 100 patients divided into two groups of 50 each. Group A: 50 diabetic patients with IHD.Group B: 50 diabetic patients without IHD.
Sampling Method : Convenience sampling (non-probability).
Duration of Study : Six months after acceptance of synopsis.
Inclusion Criteria
1. Biochemically proved diabetics with or without history of IHD.
2. Age more than 40 years and less than 60 years.
3. Patients on oral hypoglycemic.
Exclusion Criteria
1. Type1 DM.
2. Known cases of hyperlipidemia.
3. Patients with advanced liver or renal disease or malignancy.
Data Collection Procedure
The study population will include diabetic patients presenting in OPD and emergency of Holy Family Hospital Rawalpindi. First 50 diabetic patients with IHD will be selected in group A and first 50 patients without IHD will be selected in group B.
Statistical Methods
The SPSS software version 11.0 will be used to analyze the data in the form of tables and graphs. Test of significance will be t-test and chi square test.
Similar Preliminary Studies
1. Frier BM, Fisher BM.Diabetes Mellitus.In: Davidson’s Principles and Practice of Medicine. 19th edition. Edinburgh: Churchill Livingstone; 2002.
2. WHO-MONICA project: Myocardial infarction and coronary deaths in the WHO-MONICA project: registration procedure evens rates and case fatality rates in 38 populations from 21 countries in four continents Circulation 1994; 90:583.
3. .Berglund G, Friksson KF, Israelsson B,Kjelstrom T, Lindgarde F, Mattiason I et al. Cardiovascular risk groups and mortality in an urban Swedish male population. J Intern Med 1996; 239(6): 489-97.
4. Fuller JH, Stevens LK, Wang SL. Risk factors for cardiovascular mortality and morbidity. The WHO multinational study of vascular disease in diabetes. Diabetologia. 2001; 44:S54 – S64.
5. Song SH, Brown PM. Coronary artery disease risk assessment in DM Comparison of UKPDS risk engine with Framingham risk assessment function and its clinical implications. Diabetic Medicine. 2004; 21(8): 238-45.
6. Hanefeld M, Fischer S , Julius U, Schulze J, Schwanebeck U, Schmechel H et al. Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia. 1996; 39:1557-83.
7. Turner R,Gull G,Holman R,United Kingdom prospective Diabetes stud,7-9 years update of randomized controlled trial on the effect of improved metabolic control on complications in Non Insulin dependent diabetes mellitus. Am Inter Med.1996:136-45.
8. Naheed T, Khan A, Masood G, Younis BB, Chaudhry MA. Dyslipidemia in TYPE 2 DM patients in teaching hospital of Lahore Pakistan. Pak J Med Sci. 2003; 19(4):283-86.
9. Khan MS, Moin S.Prevalence of cardiovascular risk factors in type 2 Diabetic patients with Ischaemic heart disease. Pak Armed Forces Med J.2005;55(1):8-1

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