Introduction
Diabetes is a chronic complex metabolic disorder leading to impaired glucose tolerance and hyperglycemia, which in turn lead to end organ failure. As per the WHO report, every year about 422 million people have diabetes and 1.5 million deaths are directly due to diabetes (1). Both diabetes and cardiovascular diseases are characterized by subacute inflammation and resistance to insulin. Under the stimulus of various risk factors, it is evident that in the natural pathway of diabetes, inflammatory mediators play a major role (2).
Atherosclerosis is an inflammatory disease of the arteries, occurring as a result of arterial wall lesions, due to lipid retention in the intima and hence classically associated with altered lipid metabolism and hypercholesterolemia (3). Atherosclerotic cardiovascular events are among the major causes of illness, complications, and death among diabetic individuals.
Carotid Intima media thickness, being simple and noninvasive, is widely used as a marker of atherosclerosis as it can detect early atherosclerotic vascular changes (4). The thickness of intima and media can signal the presence of atherosclerosis (plaque build-up), even in its earliest stages even before any symptoms develop. As atherosclerosis advances, risk of cardiovascular disease increases; thus, CIMT helps in early identification and in planning preventive measures (5).
SGOT is an enzyme present in the liver, skeletal muscle, brain, red blood cells, and the heart. High concentrations of SGOT may indicate damaged tissues, especially an injury of the heart due to a heart attack (6). Only limited evidence is available to support relationship between increased cardiovascular risk and SGOT (7), so this study was conducted to establish this relationship.
Objective
To study the correlation of CIMT with SGOT in diabetic individuals.
Materials and methods
For this hospital-based analytical cross-sectional study, 29 diabetic patients attending General Medicine OPD of Sree Gokulam Medical College and Research Foundation, Trivandrum, for a period of 2 weeks from February 17/2/2024 to 29/2/2024 were selected using consecutive sampling. We excluded patients with any underlying liver or kidney disease, history of coronary artery disease, history of alcohol abuse, and history of recent hospitalization (last 2 weeks) for any acute infection. The study was conducted after obtaining Institutional ethics committee clearance. A detailed pro forma was filled out for each patient, which included age, sex, CIMT, and laboratory parameters including FBS, HbA1c, and SGOT. CIMT was done as part of screening, measured using B mode ultrasound at common carotid artery. According to the European Society of Cardiology (ESC), CIMT values greater than 0.90 mm are considered as a tool to predict atherosclerotic events (8). Blood samples were taken and SGOT measured using a clinical chemistry analyzer. Normal SGOT was taken as 8 to 40IU/l. Collected data were analyzed using the SPSS statistical data package. Quantitative data were expressed as mean +/- SD and qualitative data expressed as percentage. The correlation between SGOT and CIMT was analyzed using Pearson correlation analysis.
Results
A total of 29 diabetic patients were selected for the study, of whom 34.5% were female while 65.5 % were male (Table 1). The various patient characteristics are mentioned in Table 2. The mean age was 66.32 ± 10.981. The maximum HbA1c was 12 with a mean 7.65. 55% of the patients had CIMT more than 0.9 mm (Figure 1), the mean CIMT being 1.0345, with maximum value of 2.10. Table 3 shows correlation of CIMT with various parameters. A positive correlation was found between CIMT with FBS and HbA1C with p<0.001, with r value 0.812 and 0.709, respectively. We found statistically significant correlation between SGOT and CIMT, r = 0.415 with a p-value of 0.025 (Figure 2). However, the mean SGOT was 27.79 and maximum 49.
Table 1. Classification of cases according to gender.
Table 2. Baseline characteristics of patients.
Figure 1. Classification of cases according to carotid intima media thickness.
Table 3. Correlation of CIMT with Age, FBS, HbA1C, and CIMT.
Figure 2. Correlation of CIMT with SGOT.
Discussion
CIMT was more in patients with high FBS and uncontrolled diabetes. CIMT can be used as a tool for screening early atherosclerosis in diabetic patients. Only limited evidence is available to support the relationship between increased cardiovascular risk and SGOT (7), so this study was conducted to establish this relationship. In the study by Aisah et al. (9), no relationship was found between higher SGOT and major adverse cardiovascular events including stroke and ischemic heart disease (p-value 0.434). In a study conducted by The Atherosclerosis Risk in Community (ARIC), it was found that, higher SGOT levels even within the normal range, were independently associated with atherosclerosis and subclinical myocardial injury (10, 11). The Framingham Offspring Heart Study did not show an association between AST and all-cause or CVD-related mortality over 20 years of follow-up in subjects with AST within normal range (12). We found a statistically significant correlation between SGOT and CIMT, r = 0.415 with a p-value of 0.025. SGOT was higher in patients with increased CIMT. Hence SGOT can be used as a marker to prognosticate atherosclerotic cardiovascular events in diabetic individuals.
Conclusion
SGOT is having a positive correlation with CIMT in diabetic patients. SGOT can be used to prognosticate adverse atherosclerotic cardiovascular events in diabetic patients early, as it is reliable and cheaper. Studies with more sample size need to be performed to establish this relationship.
References
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