To Assess The Impact Of Smoking On Cardiomyopathy In Individuals With Diabetes

Abstract

Diabetes mellitus is a metabolic disorder associated with a variety of complications in individuals with poor glycaemic control. Cigarette smoking is one of the harmful risk factors to exacerbate coronary and peripheral disease. It has been shown to cause impairment in coronary blood flow response which increases the risk of myocardial ischemia in patients. The long-lasting DM leads to DCM and along with smoking the severity of DCM is intensified. The present study was conducted to determine the role of smoking in the early onset of diabetic cardiomyopathy. It was a cross sectional study conducted on total 150 males among which 75 were smokers and 75 were non-smokers of age 40 to 70 years. Selected participants were requested to fill a questionnaire regarding socio- demographic data, smoking habits, severity and characteristics of cardiomyopathy, stress, lifestyle and family’s medical history. Their anthropometric indices were measured, blood samples were taken in which glucose level, HDL, LDL and triglycerides level were checked and body vitals were also measured. The patients underwent a complete ECG and echocardiography to evaluate difference of heart anatomy and physiology of diabetic smokers and non-smokers. (Barengo et al., 2017)

 In anthropometric indices, body mass index and waist-to-hip ratio show significant difference with p-value of 0.025 and 0.018 respectively. Systolic BP and pulse rate give significant difference with p-value of 0.000. Total cholesterol, triglyceride, high density lipoprotein and low-density lipoprotein show significant difference with p-value 0.000 of each. Age is also directly linked to onset of DCM showing significant difference at p-value 0.028. Body fat percentage, diastolic blood pressure and fasting plasma glucose do not reveal any significant difference between diabetic smokers and non-smokers.

 The most prominent symptoms observed in smokers are breathing trouble, chest pain, swelling of abdomen, and fatigue while there is a significant difference in breathing trouble, swelling of abdomen and swelling of legs and feet. 27% of smokers have been smoking for 21 to 30 years while 90.7% smokers had family history of diabetes mellitus. The odds were estimated which showed that diabetic smoker are 1.16 times more likely to have increased BMI, 1.142 times more at risk of having high body fat percent, 1.037 and 1.045 times more likely to have high systole BP and pulse rate respectively. FPG, total cholesterol, triglyceride and LDL are 1.001, 1.096, 1.063 and 1.087 times more likely to increase respectively in diabetic smokers than non-smokers. FPG shows remarkable correlation with age, body fat percentage and diastolic BP. Total cholesterol, triglyceride and LDL show correlation with and systolic BP, pulse rate. The transthoracic echocardiography examination revealed that ejection fraction of smokers was 29.1 ± 6.0. The mitral valve thickness was found to be +12.5% and the mitral E_a/A_a observed was -8.1%. The increased in left ventricular mass was also detected. Posterior wall thickness was found to be 18. The ejection fraction of non-smokers was 34.6% ± 4.0 whereas mitral valve thickness was +9.9% and a decrease of -6.5% in the mitral E_a/A_a. Posterior wall thickness of non-smokers was 14.

Hence the findings suggest that smoking in the presence of diabetes mellitus have increased risk of diabetic cardiomyopathy. Smoking increases hypertension and also leads to dyslipidaemia. Moreover, it also hinders in the mitral and tricuspid flow. Therefore, Smoking is the vital factor that stimulates the early onset of diabetic cardiomyopathy.