Prevalence and Patterns of Coronary Artery Disease among Patients with Diabetes in a Resource-Limited Setting: A Pioneer Comparative Cross-Sectional Study

Abstract

Introduction : Diabetes mellitus is a major risk factor for Coronary Artery Disease (CAD) and is associated with more severe clinical and anatomical presentations. However, data regarding the specific characteristics of CAD in diabetic patients from Sub-Saharan Africa remain limited and are virtually non-existent in Central Africa. Aims: In this pioneer study, we aimed to investigate the clinical, angiographic, and therapeutic specificities of Coronary Artery Disease (CAD) in diabetic patients within a sub-Saharan African context. Methods: We conducted a comparative cross-sectional study based on the DéRICA registry at the Yaoundé General Hospital, Cameroon. We included 82 consecutive patients (27 diabetics and 55 non-diabetics) undergoing coronary angiography. Results: The mean age was 60 years for both groups. Diabetic patients exhibited a significantly higher prevalence of dyslipidemia (81.5% vs. 41.8%; p = 0.001) and prior ischemic heart disease (77.8% vs. 43.6%; p = 0.004). Angiographically, diabetes was strongly associated with more severe anatomical coronary involvement. Diabetics were four times more likely to present with three-vessel disease (37.0% vs. 12.7%; OR = 4.03, 95% CI [1.33 - 12.28]; p = 0.011). Crucially, diabetes was associated with a sevenfold increase in Left Main Coronary Artery (LMCA) involvement (22.2% vs. 3.6%; OR = 7.57, 95% CI [1.41 - 40.55]; p = 0.014). Consequently, Heart Team discussions were significantly more frequent for diabetic patients (29.6% vs. 9.1%; p = 0.025). Conclusion: In Cameroon, diabetic patients with CAD present with a markedly higher anatomical risk profile, characterized by diffuse three-vessel disease and critical LMCA lesions. These findings underscore the critical importance of early cardiovascular screening and multidisciplinary management in this high-risk population.