ANALYSIS OF CLINICAL AND ANAMNESTIC PARAMETERS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CORONARY ARTERY DISEASE WITH DIFFERENT COURSES OF THE DISEASE

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 24 ANALYSIS OF CLINICAL AND ANAMNESTIC PARAMETERS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CORONARY ARTERY DISEASE WITH DIFFERENT COURSES OF THE DISEASE Sh.Sh. Mukhtarova¹, R.Kh. Trigulova², D.D. Khudoyberdieva³ Tashkent State Medical University¹,³ Republican Specialized Scientific and Practical Medical Center of Cardiology² https://doi.org/10.5281/zenodo.17982486 Abstract. Aim: To evaluate the clinical and anamnestic parameters in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) with different courses of the disease. Materials: A total of 130 patients with T2DM and CAD with varying left ventricular ejection fraction (LVEF) were examined. The mean age was 65.6 ± 9.7 years, and the duration of T2DM and CAD was 8.8 ± 5.2 and 7.5 ± 3.6 years, respectively. Results: The analysis demonstrated that 56.9% (n = 74) of patients with type 2 diabetes mellitus and very high cardiovascular risk achieved the target HbA1c level of ≤8%. An HbA1c level ≥8% persisted in 43.0% (n = 74) of patients, after adjustment for age. In patients with HbA1c ≥8%, the duration of coronary artery disease and type 2 diabetes mellitus was respectively 1.5 and 1.2 times longer compared with patients with HbA1c ≤8%. In contrast, the incidence of atrial fibrillation paroxysms was 4.5 times higher in the HbA1c ≤8% group. Conclusion: The identified relationships demonstrated a positive association between fluctuations in HbA1c levels and the risk of macrovascular complications. Keywords: type 2 diabetes mellitus; coronary artery disease; cardiovascular events; ejection fraction. Introduction. Type 2 diabetes mellitus (T2DM) is associated with increased cardiovascular morbidity and mortality [1]. Patients with T2DM have a twoto four-fold increased risk of developing coronary heart disease (CHD), ischemic stroke, and a 1.5to 3.6-fold increased risk of mortality [1]. T2DM is also a major risk factor for heart failure, peripheral arterial insufficiency, and microvascular complications affecting quality of life and life expectancy. Despite advances in cardiovascular disease (CVD) treatment and prevention, which have contributed to a significant reduction in diabetes-related coronary mortality [2], cardiovascular morbidity and mortality still remain high in most patients with diabetes. Given the growing number of survivors of cardiovascular events and the global epidemic of T2DM, the number of patients with T2DM with high cardiovascular risk is expected to increase. Diabetes has long been considered the "equivalent of cardiovascular risk." This assertion was supported by the results of a study [3] in which patients with type 2 diabetes who had no history of coronary artery disease had the same coronary mortality rate as patients without diabetes who had previously had chronic coronary syndrome. The presence of type 2 diabetes also increased coronary mortality rates, giving the patient a worse prognosis after the first registered case of coronary artery disease [4]. These arguments led to the 2001 NCEPATP III [5] recommending the treatment of patients with diabetes as a separate high-risk category SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 25 without the need for stratification. Recent data suggest that the risk of coronary artery disease in type 2 diabetes is not always similar to the risk of patients with preexisting CVD and is highly heterogeneous. In particular, a meta-analysis of 13 epidemiological studies (45,108 patients with and without diabetes) showed that in patients with type 2 diabetes without prior coronary artery disease (CAD) the risk of CAD was 43% lower compared with patients without diabetes with a prior myocardial infarction [6]. And in a cohort [7] including 1,586,061 people aged 30–90 years (10-year follow-up), the risk of CAD was significantly lower among patients with type 2 diabetes without CAD than in patients with CAD without diabetes. Objective: to evaluate clinical and anamnestic parameters in patients with type 2 diabetes and coronary artery disease (CAD) with different disease progressions. Material and methods. The study included 130 patients with type 2 diabetes (WHO, 1999) and coronary artery disease (CAD) aged 65.6 ± 9.7 years. The duration of CAD and coronary artery disease was 8.8 ± 5.2 and 7.5 ± 3.6 years, respectively. All patients were divided into two groups: one with a favorable outcome (Group 1, n = 90, 69.23%) and one with 1 acute myocardial infarction, 1 death, 1 stroke, 2 PCIs, 3 atrial fibrillation events, 2 destabilizations, and 30 hospitalizations during the two-year follow-up period (Group 2, n = 40, 30.7%). Given the limited number of hard endpoints, an analysis was also conducted on patients hospitalized for angina destabilization (subjective symptoms). Of the 92 parameters analyzed, only those with statistically significant differences were selected for discussion. Also included were background therapy: anticoagulants, antiplatelet agents, nitrates, beta-blockers, RAAS blockers, statins, empagliflozin, and antihistamines. The follow-up period was 2 years. Statistical analysis was performed using the nonparametric one-way Kruskal-Wallis analysis of variance. Results. The analysis showed that by the 2nd year of follow-up, the incidence of AF in Group 2 was 7.5% compared to 0% in Group 1, PCI was 5% versus 0%, and hospitalizations due to destabilization were 87.5% versus 0%, respectively. Analyzing the intragroup situation, it is evident that both groups experienced a statistically significant reduction in the number of CAG procedures: 7.5 times in Group 1 and 7 times in Group 2 (p = 0.000). In Group 1, the number of adverse events such as AF paroxysms, myocardial infarction, PCI, life-threatening arrhythmias, stroke, and hospitalizations was zero, while in Group 2 there was a decrease in episodes of AF by 1.6 times, myocardial infarction by 9 times, PCI by 5 times, and stroke by 3 times. One patient died during the entire follow-up period. (Table 1). Table 1. Analysis of the frequency of clinical and anamnestic parameters in patients with type 2 diabetes and coronary artery disease with different disease courses, abs (%). Parameters, %, (n) Favorable course (n=90, Group 1) Unfavorable course (n=40, Group 2) (t, P) FPG (mmol/L) 46.7% (42) 42.5% (17) 2,042; 0,153 53.3% (48) 50.0% (20) 0,071; 0,789 (t, P) 1st vs 2nd visit 1.004, 0316 7.407, 0.006 CAG 16.7% (15) 17.5% (7) 3,882; 0,049 2.2% (2) 2.5% (1) 0,032; 0,859 (t, P) 1st vs 2nd visit 11.294, 0.001 30.435, 0.000 AF 10.0% (9) 12.5% (5) 4,232; 0,04 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 26 0.0% (0) 7.5% (3) 11,111; 0,001 (t, P) 1st vs 2nd visit 9.890, 0.002 3.200, 0.074 MI 41.1% (37) 22.5% (9) 2,333; 0,127 0.0% (0) 2.5% (1) 3,448; 0,063 (t, P) 1st vs 2nd visit 58.730, 0.000 33.862, 0.000 PCI 31.1% (28) 25.0% (10) 1,28; 0,258 0.0% (0) 5.0% (2) 7,143; 0,008 (t, P) 1st vs 2nd visit 38.889, 0.000 32.000, 0.000 Life-threatening arrhythmias (LTA) 11.1% (10) 5.0% (2) 1,786; 0,181 0.0% (0) 0.0% (0) Nan (t, P) 1st vs 2nd visit 11.111, 0.001 7.143, 0.008 Stroke 4.4% (4) 7.5% (3) 4,0; 0,046 0.0% (0) 2.5% (1) 3,448; 0,063 (t, P) 1st vs 2nd visit 4.167, 0.041 4.938, 0.026 Hospitalizations 0 32 (t, P) 1st vs 2nd visit Mortality 0.0% (0) 2.5% (1) 2,564; 0,109 The analysis of the prescribed anti-ischemic therapy showed the following. Slightly more often (although not statistically significant) in the group of patients with unplanned hospitalizations, angiotensin receptor blockers (ARBs) (p=0.01), loop diuretics (p=0.01), and rosuvastatin (p=0.006) were prescribed. Moreover, by the end of the observation period, their number increased significantly. Calcium channel blockers (CCBs) were prescribed significantly more often in the unplanned hospitalization group both at the beginning and at the end of the study, on average p=0.01. Analysis of the dynamics of pharmacological therapy revealed interesting trends in the group of patients with hospitalizations. By the end of the observation period, there was a significant decrease in the number of patients taking ACE inhibitors (ACE-Is). Their proportion decreased 1.9-fold, from 13.3% to a lower level, which is a statistically significant change (p=0.01). At the same time, in the group of patients with unplanned hospitalizations, there was a substantial increase in the number of patients receiving diuretic therapy. This increase also reached statistical significance (p=0.003). Patients in both groups received empagliflozin in various doses at baseline (p=0.108), and by the end of the observation period, the dosage was increased for some patients (p=0.06). DPP-4 inhibitors were prescribed more frequently to patients with repeated hospitalizations, both at baseline (p=0.01) and at the end of the observation (p=0.008). The number of patients taking metformin increased significantly in the favorable group (by 7%). At the beginning of the observation period, the number of patients receiving DPP-4 inhibitors was higher in group 2 (p=0.015), and their number increased significantly by the end of the observation period (p=0.008). The analysis of HbA1c trends against the background of ongoing antihyperglycemic and basic cardiological therapy, depending on disease progression, was conducted in two directions. The first direction involved comparing ∆↓ HbA1c in patients with favorable and unfavorable disease courses (hospitalizations and events). The ratio of patients with HbA1c levels ≥8% and ≤8% was practically the same (p=0.39). It was found that in patients with an unfavorable course SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 27 in the ≥8% group, ∆↓ HbA1c was -1.28±2.60%, compared to 0.55±1.05% in the ≤8% group, with high statistical power (t=8.729, p=0.003) (Table 2). Table 2. Direction of HbA1c changes against the background of ongoing antihyperglycemic and basic cardiological therapy depending on disease course, abs (%). Favorable; n=90 Unfavorable; n=40 Glycated Hemoglobin ∆↓ HbA1с -0.05±1.23 ∆↓ HbA1с 0.04±1.82 ≥8% ≤8% ≥8% ≤8% n=33 (36.7%) n=57 (63.3%) n=11 (27.5%) n=29 (72.5%) χ² = 4.245, р = 0.39 ∆↓ HbA1с -0,27±1,57 0.07±0,96 -1,28±2,60 0,55±1,05 Kruskal t=0,531 p=0,466 Kruskal t=8,729 p=0,003 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 28 Conclusion. It was found that in patients with an unfavorable course of disease, the frequency of recurrent events was statistically significantly lower: atrial fibrillation (AF) by 1.6 times (p=0.07), myocardial infarction (MI) by 9 times (p=0.000), deaths by 1, percutaneous coronary intervention (PCI) by 4.9 times (p=0.000), heart failure (HF) by 0, and stroke by 4 times (p=0.02). The proportion of hospitalizations without objective reasons was 23.3% against the background of baseline cardiological and antihyperglycemic therapy including empagliflozin. In the group with hospitalizations, there was a 2.5-fold decrease in the number of patients receiving ACE inhibitors (p=0.001), accompanied by a 1.1-fold increase in the prescription of sartans, in contrast to their decreased use in the favorable course group, and a more pronounced increase in the prescription of ARNI class drugs in the favorable group. Analysis of therapeutic strategies revealed significant differences in the prescription of dipeptidyl peptidase-4 inhibitors (DPP-4i) between patient groups. In the group with recurrent hospitalizations, these drugs were prescribed more frequently (p=0.015), and by the end of the observation period, their use had increased 1.6-fold (p=0.008) compared with patients demonstrating a favorable course of the disease. Regarding glycemic control, both groups showed an increase in the number of patients achieving target glycated hemoglobin (HbA1c) levels. 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