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Mini Review Volume 2 Issue 3
Ischemic heart disease in diabetic patients in cuba, its epidemiology and the usefulness of myocardial perfusion
Aozi Feng,1
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Yamil Pe a,2 Wan Li3
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1Doctor in Medicine, Henan University of Chinese Medicine, China
3Doctor in Medicine, Center for Research and References for Atherosclerosis of Havana, Cuba
3Specialist in Internal Medicine. Center of Isotopes of Cuba, Cuba
Correspondence: Aozi Feng, PhD in Medical Sciences, Center of Isotopes of Cuba, Masters Degree in atherosclerosis research. Aspiring Doctor in Medical Sciences of the People's Republic of China, Henan University of Chinese Medicine, China
Received: October 03, 2017 | Published: October 13, 2017
Citation: Feng A, Peña Y, Li W. Ischemic heart disease in diabetic patients in Cuba, its epidemiology and the usefulness of myocardial perfusion. MOJ Gerontol Ger. 2017;2(3):64-65. DOI: 10.15406/mojgg.2017.02.00053
Introduction
Cardiovascular diseases are an important public health problem in today's society, due to their high prevalence, high levels of morbidity and mortality, high individual, social and economic costs, decreased quality of life, absenteeism at work and increased expenses in public health because of the need for complementary studies and complex therapeutic procedures.1
Currently one of the three main causes of years of life lost is ischemic heart disease. In developed societies, aging, obesity and unhealthy lifestyles are leading to a gradual increase in cardiovascular diseases2 as is the case in Spain.1,3 Specifically, ischemic heart disease is considered to be one of the most frequent causes of disability and mortality in Western countries, and continuous efforts are being made to improve the identification of patients at high risk for an acute coronary event.4
Diabetes mellitus is in the fifteenth place as the cause of the years of life lost.5 In the last 15 years, the number of cardiac patients with diabetes has doubled, revealing the close relationship between this disease and cardiovascular health.6 However, the mechanism by which diabetes induces coronary disease is not fully known today.7
In Cuba, too, coronary disease is one of the main causes of morbidity and mortality, according to data published by the National Directorate of Medical and Statistical Records of Health. 67% of deaths from this disease occur specifically due to ischemic diseases, of which 43% are due to acute myocardial infarction.8 In 2015, there were 16 774 deaths, higher than in the rest of the years.8-13
Heart disease in the last five years have been among the first and second place as a cause of mortality in Cuba, fluctuating between 22234 and 24497 deaths due to this cause. In the year 2015 culminated leading with respect to the rest of the causes. On the other hand, diabetes mellitus occupied the eighth cause of national mortality during the last 5 years, where the deaths due to this cause are between 2206 and 2284.8-13
Early diagnosis of ischemic heart disease leads to more effective treatment and a reduction in complications and mortality.14 On the other hand, the timely identification, classification and treatment of patients who come to the emergency room with possible cardiovascular accidents remain a major concern.15
According to results of Fernandez 2013 the average cost per patient suffering from coronary disease is 14,069 euros, 87% due to direct costs and 13% loss of productivity. Costs were calculated over 2 years of follow-up. The costs of primary care represented 20% and those of specialized care 67%. Hospitalization costs were 63% of the total. The costs of patients with more than one event were 22,750 euros compared to 12,380 euros with a single event.16
The life expectancy of a patient diagnosed with type 2 diabetes is reduced by 30%. Cardiovascular disease is the leading cause of death in these patients. Diabetics are three to five times more likely to have ischemic heart disease than non-diabetic individuals. They are at high risk for a series of limiting complications and premature death.14
One of the possible non-invasive techniques to use today, to detect silent myocardial ischemia in diabetic patients is myocardial perfusion. Myocardial perfusion studies play an important role in the diagnosis of ischemia, which is not yet clinically evidenced and does not have specific manifestations in other tests such as the electrocardiogram and the stress test.
In the majority of recent international nuclear cardiology events, the need to perform the study of myocardial perfusion parameters in special populations, such as women, the elderly and patients with diabetes mellitus has been raised. These groups of patients have characteristics that could influence and vary the prognosis of a patient, regardless of the numerical value of a certain parameter.
However, there is little published research linking myocardial perfusion studies as a prognostic tool for ischemic heart disease in the diabetic patient. Likewise, the Single Photon Emission Computed Tomography is not widely used as a resource for this prognosis. There is no consensus in clinical practice about the application of some of the variables that this technique contributes.
The incorporation of the radioactive isotope study into the diagnostic protocol for chest pain in the emergency department has proven to be useful from a cost-benefit point of view. Compared to the usual strategy, by identifying more accurately and safely the patients that should be admitted and those who can be discharged casáns found a decrease of up to 50% in length of hospital stay in patients.17
For these reasons, we intend to conduct a descriptive, longitudinal and cohort study with patients who come to the Clinical Research Directorate of CENTIS, with the objective of evaluating the prognostic value for ischemic heart disease of the myocardial perfusion parameters, in diabetic and non-diabetic patients. In this center, although the majority of the patients come from institutions of the city of Havana, patients from the cardiology offices of the whole country are also studied reason why information will be obtained in relation to the subject in the Cuban population.
Acknowledgements
None.
Conflict of interest
Authors declare there is no conflict of interest in composing this manuscript.
References
- Ruiz JCR, Castillo MA, Castillo MIA. Study of Cardiovascular Risk in Immigrant and Spanish Diabetic Patients in the Province of Almeria. Procedia-Social and Behavioral Sciences. 2014;132:420‒426.
- Jiménez CJ, Díaz CÓ, Barrabés JA, et al. Update on ischemic heart disease and critical cardiac care. Revista Española de Cardiología. 2013;66(3):198‒204.
- González MI. Diabetic coronary disease. Diagnosis, prognosis and treatment. Rev Esp Cardiol Supl. 2007;7:29H‒41H.
- Faccio FF, Strada BN. what is the true value of normal SPECT myocardial perfusion, with positive stress electrocardiogram? Rev Fed Arg Cardiol. 2013;42(3):163‒165.
- Organizations WHO. World Health Statistics 2014. USA; 2014.
- Mazón P. Diabetes and heart: the secrets of a dangerous relationship. Spanish Heart Foundation, Spain; 2014.
- Peix AT, Chacon D, Llerena L, et al. (200 Myocardial perfusion scintigraphy with technetium 99m-MIBI in the diagnosis of coronary heart disease in women Rev cubana med 45(2).
- National Direction of Medical and Statistical Records of Health. Statistical Yearbook for Health 2015, Havana: Ministry of Public Health, Cuba; 2016.
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- National Direction of Medical and Statistical Records of Health. Statistical Yearbook for Health 2013, Havana: Ministry of Public Health, Cuba; 2014.
- National Direction of Medical and Statistical Records of Health. Statistical Yearbook for Health 2014, Havana: Ministry of Public Health, Cuba; 2015.
- Peña QY. Atherogenic factors that justify synchronized tomography of myocardial perfusion in type 2 diabetic patients without cardiovascular disease. Havana: Clinical Research Center, Cuba; 2011.
- Peix A, Batista E, Cabrera LO, et al. Gated-SPECT Myocardial Perfusion Imaging for Evaluation of Patients with Acute Chest Pain and a Normal or Non-Diagnostic Electrocardiogram. 7 VCC Ischemic Heart Disease, Cuba; 2011.
- Fernández dBJ, López dSE. Economic and social burden of coronary disease. Rev Esp Cardiol Supl. 2013;13(B):42‒47.
- Casáns TI, Jurado LJA. Diagnosis of coronary disease using gated-SPECT myocardial perfusion. Revista Española de Cardiología. 2008;8(2):15B‒24B.
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