CORRELATION OF ECHOCARDIOGRAPHIC AND BIOCHEMICAL PARAMETERS DEPENDING ON ACHIEVEMENT OF TARGET GLYCATED HEMOGLOBIN LEVELS AND AGE IN PATIENTS WITH TYPE 2 DIABETES AND CORONARY ARTERY DISEASE

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 4 CORRELATION OF ECHOCARDIOGRAPHIC AND BIOCHEMICAL PARAMETERS DEPENDING ON ACHIEVEMENT OF TARGET GLYCATED HEMOGLOBIN LEVELS AND AGE IN PATIENTS WITH TYPE 2 DIABETES AND CORONARY ARTERY DISEASE Sh.Sh. Mukhtarova1, R.Kh. Trigulova2, M.A. Ganijonova3 Tashkent State Medical University1,3 Republican Specialized Scientific-Practical Medical Center of Cardiology2 https://doi.org/10.5281/zenodo.17906406 Abstract. Objective: To conduct a correlation analysis of echocardiographic (EchoCG) indicators and biochemical parameters based on the achievement of target glycated hemoglobin levels (HbA1c) and age in patients with type 2 diabetes (T2DM) and coronary artery disease (CAD). A total of 130 patients with T2DM and CAD were examined, aged 65.6 ± 9.7 years, with disease duration of 8.8 ± 5.2 and 7.5 ± 3.6 years, respectively. Analysis showed that among patients with T2DM at very high cardiovascular risk included in the study, 56.9% (n=74) achieved the target HbA1c level ≤8%. HbA1c ≥8% persisted in 43.0% (n=56), considering age. In patients with HbA1c ≥8%, the duration of CAD and T2DM was 1.5 and 1.2 times higher than in the group with HbA1c ≤8%. Meanwhile, the frequency of atrial fibrillation (AF) paroxysms was 4.5 times higher in the group with HbA1c ≤8%. 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, heart failure, cardiovascular events, glycated hemoglobin, echocardiography. Introduction. Metabolic disorders characteristic of type 2 diabetes mellitus (T2DM) are often combined with other cardiovascular risk factors. T2DM can act as a catalyst for a number of adverse changes, including accelerated formation of atherosclerotic plaques not only in coronary arteries but also in the systemic circulation. Endothelial damage of blood vessels is also observed, impairing normal vascular function. Dysfunction of the autonomic nervous system and excessive collagen accumulation in the extracellular matrix are additional complications associated with T2DM [1]. Diabetic cardiomyopathy deserves special attention. Interestingly, heart failure (HF) can in turn increase the risk of developing T2DM, and the manifestation of diabetes in the setting of HF is associated with a worse prognosis. Disorders of carbohydrate metabolism are often accompanied by other cardiovascular risk factors, including arterial hypertension, obesity, and dyslipidemia. These factors, recently included in the updated definition of HF, are considered primary predictors of its development. T2DM can independently accelerate the progression of coronary and systemic atherosclerosis, induce vascular changes, impair autonomic regulation, and stimulate excessive collagen deposition in the extracellular matrix. Such multifactorial influences complicate individual risk assessment, leaving open the question of how much the adverse outcome is due directly to glycemic abnormalities versus the cumulative effect of multiple risk factors. In addition, T2DM is associated with an atherogenic lipid profile, elevated blood pressure, chronic subclinical inflammation, impaired renal function, and accumulation of advanced SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 5 glycation end-products (AGEs). All of these factors contribute to increased cardiovascular risk [2]. Impaired endothelial function is closely linked to an unfavorable lipid profile and vascular inflammation. These factors stimulate the production of pro-atherogenic signaling molecules such as Pselectin, vascular growth factors, and transforming growth factor-β, which are responsible for generalized vascular system damage. Type 2 diabetes mellitus (T2DM) causes complex disturbances in the cardiovascular system, affecting various structural levels. Changes occur both in large anatomical structures and at the microscopic level of tissue organization. The interaction of macroand microstructural alterations forms a complex disease profile, requiring a comprehensive diagnostic and therapeutic approach for patients with T2DM and concomitant cardiovascular disorders. Statistical data show a high prevalence of concomitant metabolic disorders among patients with T2DM: approximately 90% are overweight or obese, 70% have dyslipidemia, and nearly 70% suffer from arterial hypertension [3,6]. This combination of risk factors creates a complex pathophysiological scenario that significantly increases the likelihood of cardiovascular complications in T2DM patients. Evidence from experimental, observational, and randomized controlled trials clearly demonstrates a bidirectional relationship between T2DM and heart failure (HF). Patients with T2DM have an increased risk of new-onset HF and HF-related events. Conversely, patients with HF have an elevated risk of developing T2DM. Both T2DM in the presence of HF and HF in the presence of T2DM are associated with worse outcomes. These findings have become even more relevant in light of new therapeutic opportunities provided by SGLT2 inhibitors [4,5]. Left ventricular ejection fraction (LVEF) plays a key role in HF diagnosis, prognosis, and treatment. Objective: To conduct a correlation analysis of echocardiographic parameters and biochemical indicators depending on the achievement of target glycated hemoglobin levels in relation to age in patients with T2DM and coronary artery disease (CAD). Materials and Methods. The study included 130 patients with T2DM (WHO, 1999) and CAD (ESC criteria), with an average age of 65.6 ± 9.7 years. The duration of T2DM and CAD was 8.8 ± 5.2 and 7.5 ± 3.6 years, respectively. For convenient analysis of how the studied parameters depend on achieving target HbA1c levels, patients were divided into two groups: Group 1 – target HbA1c ≤8% achieved (n=74), Group 2 – target HbA1c ≥8% not achieved (n=56). Of the 92 parameters analyzed, only those with statistically significant differences were selected for discussion. Baseline therapy included anticoagulants, antiplatelet agents, nitrates, beta-blockers, RAAS inhibitors, statins, empagliflozin, and hypoglycemic agents. The follow-up period was 2 years. Statistical processing was performed using the nonparametric Kruskal-Wallis one-way analysis of variance. Results. Analysis of echocardiographic data showed that key indicators of cardiac function remained relatively stable throughout the entire observation period. When comparing the results obtained at various stages of the study with baseline values, no statistically significant deviations were found. This indicates the absence of substantial changes in major echocardiographic parameters in the examined patients. Left ventricular ejection fraction (LVEF) and left atrial index (LA index) also did not show statistically significant changes during follow-up. However, significant intergroup statistical differences were observed: LVEF before (t=16.235, p=4.784, 0.029) and after follow-up (t=6.898, p=0.009), and LA index before (t=8.225, p=0.004) and after (t=9.253, p=0.002). Despite these statistical differences, they do not have clinical significance. Analysis of diastolic function echocardiographic parameters revealed lower values in the second group compared with the first. SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 6 Differences were observed in the E/A ratio, e′ average, and the E/e′ ratio for the mitral and tricuspid valves. Statistically significant differences were found at the first (t=4.269, p=0.039) and second (t=5.052, p=0.025) visits, and one difference did not reach significance (t=0.893, p=0.34). However, during the two-year follow-up, a highly significant improvement in main parameters characterizing LV diastolic function was noted, indirectly indicating an improvement in diastolic dysfunction. Specifically: E/A in stages 1 and 2 for both groups (t=11.301, p=0.001 and t=15.142, p=0.000), e′ average (t=7.168, p=0.007 and t=10.797, p=0.001), E/e′ (t=9.040, p=0.003 and t=23.274, p=0.000), respectively. To identify possible intergroup relationships depending on achievement of target HbA1c levels, a correlation analysis was performed between echocardiographic and biochemical parameters. Importantly, in the group that achieved the target HbA1c level, a positive correlation was identified with fibrinogen (p=0.003), CRP (p=0.003), intima-media thickness (p=0.004), and a negative correlation with ferritin (p=0.025). In patients with HbA1c ≥8%, a less pronounced but statistically significant correlation was found with fibrinogen (p=0.056), CRP (p=0.009), left atrial volume index (p=0.025), intima-media thickness (p=0.001), left ventricular hypertrophy (p=0.01), and >50% stenosis of the anterior descending artery (p=0.02). Negative correlations in the subgroup that did not achieve HbA1c ≥8% were found with total CPK (p=0.036), ApoA (p=0.006), and ApoB (p=0.005) (Table 1). Table 1. Results of correlation analysis in the observation groups. Indicators HbA1c ≤8%, r Р HbA1c ≥8%, r Р Fibrinogen, g/L 0,345 0,003 0,256 0,056 Total CPK (Creatine Phosphokinase), U/L -0,083 0,482 -0,281 0,036 Interleukin-6, pg/mL 0,269 0,02 0,222 0,1 CRP (C-reactive protein), mg/L 0,068 0,563 0,348 0,009 ApoA1, mg/dL 0,189 0,106 -0,364 0,006 ApoB, mg/dL 0,22 0,06 0,367 0,005 Left atrial volume index (LAVI) 0,027 0,821 0,272 0,043 Left ventricular mass index (LVMI) 0,015 0,899 -0,341 0,01 Intima–media thickness (IMT), mm 0,002 0,99 0,448 0,001 Left ventricular hypertrophy (LVH) -0,045 0,704 0,325 0,014 LAD stenosis >50% (left anterior descending artery) -0,116 0,323 0,305 0,022 Conclusion. The conducted correlation analysis revealed associations related to achieving the target HbA1c level. In the group that achieved the target HbA1c, a positive correlation was found with fibrinogen (p=0.003), CRP (p=0.003), and intima-media thickness (p=0.004), and a negative correlation with ferritin (p=0.025). Among patients with HbA1c ≥8%, a less pronounced but statistically significant correlation was observed with fibrinogen (p=0.056), CRP (p=0.009), left atrial volume index (p=0.025), intima-media thickness (p=0.001), left ventricular hypertrophy (p=0.01), and stenosis of the left anterior descending artery exceeding 50% (p=0.02). A negative SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 7 correlation in the subgroup that did not achieve HbA1c ≥8% was identified with total CPK (p=0.036), ApoA (p=0.006), and ApoB (p=0.005). REFERENCES 1. Duckworth W, Abraira C, Moritz T et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360: 129–39. doi: 10.1056/NEJMoa0808431. 2. Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. 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