Abstract
The present study was conducted to determine the clinical features of diabetic patients which might lead to myocardial necrosis. Autopsies on 141 diabetics (age: 43-85) with onset after the age of 40 years performed between 1967 and 1980, were reviewed. The subjects were divided into 3 groups according to the presence of myocardial necrosis. Group I included 45 cases with massive myocardial necrosis; Group II, 33 cases with patchy necrosis; and Group III, 63 cases without necrosis. There was no sex predominance in the incidence among each group. The autopsy findings indicated that coronary atherosclerosis and diabetic glomerulosclerosis were significantly more common in Groups I and II than in Group III (p<0.01). The clinical data showed that diabetics with elevated triglyceride levels were seen more often in Group I than in Group III (p<0.05). The duration of diabetes and the period between onset and initial treatment were also longer in Group I (p<0.01). However, the development of either massive or patchy necrosis was not significantly associated with the following parameters: modality, blood sugar, persistent proteinuria, diabetic retinopathy, blood cholesterol level, smoking history, blood pressure or body weight. On the other hand, combinations of any two factors among the three major risk factors (blood pressure, cholesterol and smoking) were seen more often in Group I than in Group III (p<0.05).
The results of this study indicated that the presence of severe coronary atherosclerosis and diabetic glomerulosclerosis were closely associated with the development of myocardial necrosis. No apparent difference in coronary atherosclerosis could be found between the group with massive necrosis and the group with patchy necrosis. Hypertriglyceridemia, a duration of diabetes of at least 10 years and a period between onset and initial treatment of at least 1 year seemed to be associated with myocardial necrosis. No significant relationship could be found between the development of myocardial infarction and any individual risk factor for coronary disease. However, the combined effects of three major risk factors may be related to the development of myocardial infarction in diabetics.
