Seventy-three patients with idiopathic primary myocardial disease, 16 of whom had diabetes mellitus, were compared to matched patients without cardiomyopathy. A statistically significant increase was observed in the frequency of diabetes in patients with idiopathic cardiomyopathy. Evolution of cardiomyopathy in a patient with preexisting diabetes and angina pectoris was also established. Four diabetic patients died; autopsies were performed on three. In these patients, the large coronary arteries were patent and free of arteriosclerosis, but small vessel changes were present in the myocardium. In contrast, autopsy findings in 28 patients who had cardiomyopathy without diabetes showed small coronary vessel disease in only one patient.
Diabetics can develop myocardial disease without large coronary artery involvement (diabetic cardiomyopathy), possibly due to pathological changes in small coronary vessels.
(JAMA 229:1749-1754, 1974)