The effect of type 2 diabetes on the prognosis of patients with coronary artery disease
Thesis event information
Date and time of the thesis defence
Place of the thesis defence
Oulu University Hospital, Lecture Hall 10
Topic of the dissertation
The effect of type 2 diabetes on the prognosis of patients with coronary artery disease
Doctoral candidate
Licentiate of Medicine Samuli Lepojärvi
Faculty and unit
University of Oulu Graduate School, Faculty of Medicine, Research Unit of Biomedicine and Internal Medicine
Subject of study
Medicine
Opponent
Professor Juhani Airaksinen, University of Turku
Custos
Professor Heikki Huikuri, University of Oulu
The effect of type 2 diabetes on the prognosis of patients with coronary artery disease
Cardiovascular diseases are the most common cause of death in the Western countries. Type II diabetes at least doubles the risk of cardiovascular disease such as coronary artery disease. Over 50% of mortality in diabetic patients is caused by CVD. Moreover, type II diabetes increases the risk of chronic heart failure and cardiac death regardless of coronary artery disease. Currently, the incidence of type II diabetes is increasing rapidly due to the global obesity epidemic. Therefore, issues related to type II diabetes and cardiovascular disease are bound to have an increased impact in society in the future.
In this thesis the correlation between biomarkers of collagen synthesis and inflammation, the amount of myocardial fibrosis estimated from cardiac magnetic resonance imaging, and diastolic properties of the left ventricle was evaluated in 63 patients. An impaired diastolic function correlated with the cardiac imaging findings and the levels of biomarkers PIIINP, Gal-3 and sST2.
In the other studies, 1946 patients with a stable coronary artery disease with or without type II diabetes were investigated and the value of biomarkers in the risk prediction among these patients was assessed. During the two-year follow-up, especially elevated high-sensitivity troponin T levels were associated with an 9.9-fold increased risk of a cardiac death or hospitalisation for congestive heart failure. During the 6.3-year follow-up, elevated high-sensitivity troponin T and elevated sST2 levels together led to a 6.4-fold increase in the risk of a sudden cardiac death compared to those with normal values among all coronary artery disease patients with or without type II diabetes. The risk of sudden cardiac death or aborted cardiac arrest was 2.6-fold higher in the diabetic patients compared to their non-diabetic counterparts. There was, however, no difference in the risk for non-sudden cardiac death. Hospitalisation for congestive heart failure was significantly more common among the diabetic patients. The annual mortality of the non-diabetic CAD patients was 0.50%, which is lower than the cardiac mortality reported in a matched general Finnish population (0.59%). In conclusion, type 2 diabetes in coronary artery disease patients results in a significantly worse prognosis. Novel risk markers such as the hs-TnT are associated with adverse events among diabetic patients with coronary artery disease. These results suggest that type 2 diabetes might have a direct effect on the myocardium, which results in an increased risk for heart failure and sudden cardiac death.
In this thesis the correlation between biomarkers of collagen synthesis and inflammation, the amount of myocardial fibrosis estimated from cardiac magnetic resonance imaging, and diastolic properties of the left ventricle was evaluated in 63 patients. An impaired diastolic function correlated with the cardiac imaging findings and the levels of biomarkers PIIINP, Gal-3 and sST2.
In the other studies, 1946 patients with a stable coronary artery disease with or without type II diabetes were investigated and the value of biomarkers in the risk prediction among these patients was assessed. During the two-year follow-up, especially elevated high-sensitivity troponin T levels were associated with an 9.9-fold increased risk of a cardiac death or hospitalisation for congestive heart failure. During the 6.3-year follow-up, elevated high-sensitivity troponin T and elevated sST2 levels together led to a 6.4-fold increase in the risk of a sudden cardiac death compared to those with normal values among all coronary artery disease patients with or without type II diabetes. The risk of sudden cardiac death or aborted cardiac arrest was 2.6-fold higher in the diabetic patients compared to their non-diabetic counterparts. There was, however, no difference in the risk for non-sudden cardiac death. Hospitalisation for congestive heart failure was significantly more common among the diabetic patients. The annual mortality of the non-diabetic CAD patients was 0.50%, which is lower than the cardiac mortality reported in a matched general Finnish population (0.59%). In conclusion, type 2 diabetes in coronary artery disease patients results in a significantly worse prognosis. Novel risk markers such as the hs-TnT are associated with adverse events among diabetic patients with coronary artery disease. These results suggest that type 2 diabetes might have a direct effect on the myocardium, which results in an increased risk for heart failure and sudden cardiac death.
Created 5.1.2026 | Updated 5.1.2026