@article {82924, title = {The Warm-Up Phenomenon in Diabetic Patients with Chronic Stable Angina}, journal = {Heart Mirror Journal }, volume = {5}, year = {2011}, pages = {393-398}, abstract = {

Background In subjects with coronary artery disease (CAD), the angina induced by initial exercise is
attenuated with re-exercise after a brief rest. This warm-up phenomenon believed to be due
to ischemic preconditioning is related to the opening of cardiac ATP-sensitive K channels (K
ATP). Blockers of these K ATP channels such as the sulphonylurea drugs can lead to loss of
ischemic preconditioning.
Objective This study aimed to examine the effects of three different sulfonylureas: glibenclamide,
gliclazide and glimepiride, on the warm-up phenomenon by analyzing the results of 2
consecutive exercise tests in diabetic patients with coronary artery disease (CAD).
Methods Forty patients with chronic stable angina: 30 patients having type 2 diabetes mellitus (DM)
and 10 non diabetic patients (group D) were enrolled in the study. The DM patients were
divided into 3 groups according to the type of sulfonylurea drug they are receiving: Group
A (glibenclamide), Group B (gliclazide) and group C (glimepiride). All the patients were
subjected to 2 consecutive exercise tests with a 15-minute recovery period between the 2 tests..
Results There was no significant increase in peak heart rate, systolic blood pressure and rate pressure
product during test 2 compared to test 1 in groups B, C and D but not in group A patients. There
was a statistically significant increase in the time to onset of chest pain (p \<0.007 for B, C and
p \<0.005 for D), time to onset of 1 mm ST segment depression (p \<0.007 for B, C and p \<0.03 for
D) and exercise duration (p \<0.01 for B; p \<0.008 for C and p \<0.02 for D) in test 2 compared to
test 1 in groups B, C and D but not in group A. There was also a significant decrease in time to ST
segment recovery to baseline in test 2 compared to test 1 in groups B,C and D (p \<0.005 in the 3
groups) but not in group A.
Conclusions Glibenclamide, but not gliclazide or glimepiride abolished the warm-up phenomenon, the
clinical counterpart of ischemic preconditioning in type 2 DM patients with CAD.

}, author = {Bakhoum SWG and Farrag A and Farghaly S} }