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Chen M, Liu J, Xie Z, Chen W, Hu Y, Wen J, Chen J, Chen X, Lin L, Wang R, Lu L. Effect of hemoglobin A1c management levels on coronary physiology evaluated by quantitative flow ratio in patients who underwent percutaneous coronary intervention. J Diabetes Investig 2024; 15:336-345. [PMID: 38009857 PMCID: PMC10906016 DOI: 10.1111/jdi.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
AIMS/INTRODUCTION The coronary physiology and prognosis of patients with different hemoglobin A1c (HbA1c) levels after percutaneous coronary intervention (PCI) are currently unknown. The aim of this study was to assess the effect of different levels of HbA1c control on coronary physiology in patients who underwent PCI for coronary heart disease combined with type 2 diabetes mellitus by quantitative flow ratio (QFR). MATERIALS AND METHODS Patients who successfully underwent PCI and completed 1-year coronary angiographic follow up were enrolled, clinical data were collected, and QFR at immediate and 1-year follow up after PCI was retrospectively analyzed. A total of 257 patients (361 vessels) were finally enrolled and divided into the hemoglobin A1c (HbA1c)-compliance group (103 patients, 138 vessels) and non-HbA1c-compliance group (154 patients, 223 vessels) according to the HbA1c cut-off value of 7%. We compared the results of QFR analysis and clinical outcomes between the two groups. RESULTS At 1-year follow up after PCI, the QFR was significantly higher (0.94 ± 0.07 vs 0.92 ± 0.10, P = 0.019) and declined less (0.014 ± 0.066 vs 0.033 ± 0.095, P = 0.029) in the HbA1c-compliance group. Meanwhile, the incidence of physiological restenosis was lower in the HbA1c-compliance group (2.9% vs 8.5%, P = 0.034). Additionally, the target vessel revascularization rate was lower in the HbA1c-compliance group (6.8% vs 16.9%, P = 0.018). Furthermore, HbA1c ≥7% (OR 2.113, 95% confidence interval 1.081-4.128, P = 0.029) and QFR decline (OR 2.215, 95% confidence interval 1.147-4.277, P = 0.018) were independent risk factors for target vessel revascularization. CONCLUSION Patients with well-controlled HbA1c levels have better coronary physiological benefits and the incidence of adverse clinical outcome events might be reduced.
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Affiliation(s)
- Mingfeng Chen
- Department of CardiologyFujian Provincial HospitalFuzhouChina
| | - Jichen Liu
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Zhangxin Xie
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of EmergencyFujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Emergency Medical CenterFujian Provincial Institute of Emergency MedicineFuzhouChina
| | - Wei Chen
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Yanqin Hu
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Junping Wen
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of EndocrinologyFujian Provincial HospitalFuzhouChina
| | - Jinyan Chen
- Institute for Immunology, Fujian Academy of Medical SciencesFuzhouChina
| | - Xuemei Chen
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of Critical Care MedicineFujian Provincial Hospital, Fujian Provincial Center for Critical Care MedicineFuzhouChina
| | - Lirong Lin
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Rehua Wang
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Lihong Lu
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
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Atherogenic index of plasma predicts coronary artery disease severity and major adverse cardiac events in absence of conventional risk factors. Coron Artery Dis 2022; 33:523-530. [PMID: 35811555 DOI: 10.1097/mca.0000000000001166] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Various overlapping risk factors lead to coronary artery disease (CAD). The atherogenic index of plasma (AIP) is a marker for CAD severity and progression. However, little is known about its contribution to the residual risk of CAD observed in the absence of all typical risk factors. METHODS A prospective cohort study of 366 Indian patients undergoing coronary computed tomography (CT) angiography and diagnosed with stable CAD. Diabetes, hypertension, hypercholesterolemia, smoking, previous CAD, alcohol or lipid-lowering medication intake, renal, liver or thyroid dysfunction were exclusion criteria. Coronary stenosis was graded using the CAD-reporting and data system (CAD-RADS™) system. Lipid profile, HbA1c, uric acid, highly sensitive C-reactive protein (hsCRP) and anthropometric measurements were taken. AIP, triglyceride/high-density lipoprotein cholesterol (HDLc) and total cholesterol (Tc)/HDLc ratios were calculated. Independent predictors of CAD severity and the occurrence of major adverse cardiac events (MACE) during 2.57 (0.52) years of follow-up were identified using logistic regression and Cox proportional hazards regression. RESULTS Sixty patients experienced a MACE during a cumulative 887.03 person-years. HbA1c, uric acid, hsCRP, Tc/HDLc and AIP were independent predictors of severe coronary lesions (CAD-RADS 4,5) on multivariate analysis with odds ratio 4.52 (2.37-8.61), 1.41 (1.08-1.84), 1.33 (1.09-1.62), 1.76 (1.27-2.44) and 1.29 (1.11-1.50), respectively. Only AIP and Tc/HDLc were independent predictors of MACE with hazard ratios of 1.41 (1.20-1.65) and 1.78 (1.33-2.39) besides patient age and CAD severity. CONCLUSION AIP is associated with both the severity of CAD and the occurrence of MACE within 3 years. It could serve as an effective marker of residual risk of CAD in patients devoid of traditional risk factors. Lipid-profile ratios, such as AIP are cost-effective and accessible parameters suitable for low and middle-income settings.
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Zheng Y, Li C, Yang J, Seery S, Qi Y, Wang W, Zhang K, Shao C, Tang YD. Atherogenic index of plasma for non-diabetic, coronary artery disease patients after percutaneous coronary intervention: a prospective study of the long-term outcomes in China. Cardiovasc Diabetol 2022; 21:29. [PMID: 35193553 PMCID: PMC8864872 DOI: 10.1186/s12933-022-01459-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/03/2022] [Indexed: 12/31/2022] Open
Abstract
Background Non-diabetic coronary artery disease (CAD) patients are thought to encounter metabolic dysfunction and while these changes may be imperceptible to the patient they probably influence outcomes. At present, there is no system to support patients sensing these subtle changes, nor is there an established model for prognoses. The Atherogenic Index of Plasma (AIP) index has already proven useful for atherosclerosis although further research is needed, especially for those without hyperglycemia. Methods This is a prospective study of 5538 non-diabetic CAD patients who had received percutaneous coronary intervention (PCI). Participants were assigned to one of three groups according to their AIP index. High AIP index cases were then compared to low index patients according to major adverse cardiac events (MACE). Restricted cubic spline (RCS) analysis was also conducted to investigate interrelations between AIP index levels and hazard ratios (HR) for MACEs. Results Patients with a high AIP index encountered metabolic dysfunction compared to those with a low AIP index i.e., higher Body Mass Index (BMI), Total Cholesterol (TC), Triglycerides (TG), and uric acid as well as lower HDL-C. Each of the aforementioned interrelations were significant with p values of less than 0.001. There was also a significant increase in the number of MACEs in the high AIP index group compared to the low AIP index group (HR: 1.37, 95% CI 1.04–1.81; p = 0.025). A J-shaped RCS curve highlighted a change in the HR after the 0.18 juncture (HR per SD: 1.20, 95% CI 0.96–1.50). Further subgroup analysis supported the main findings, all with HRs greater than one. Conclusion The AIP index could be used in prognostics for non-diabetic CAD patients 2 years after PCI. The relationship between hazard ratio and the AIP index appears to be J-shaped. Although, further multi-center studies designed for non-diabetic patients with potential metabolic dysfunction should be conducted to determine the value of the AIP index.
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Affiliation(s)
- Yitian Zheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.,Faculty of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, UK
| | - Yu Qi
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Wenyao Wang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunli Shao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Yi-Da Tang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China.
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Yu J, Gao B. Nonlinear relationship between HbA1c and coronary artery calcium score progression: a secondary analysis based on a retrospective cohort study. Diabetol Metab Syndr 2021; 13:136. [PMID: 34798910 PMCID: PMC8603599 DOI: 10.1186/s13098-021-00747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Coronary artery calcium score and glycated hemoglobin(HbA1c) are both considered risk factors for coronary heart disease. However, the relationship between coronary artery calcium score and HbA1c is still unclear. Consequently, the present study was undertaken to explore HbA1c association with coronary artery calcium score progression in South Korea. METHODS This study is a secondary analysis based on a retrospective cohort study in which 8151 participants received Health examination kits at the Health Promotion Center, Samsung Medical Center in Seoul, South Korea, from March 1, 2003-December 31, 2013. Cox proportional-hazards regression model was then used to evaluate the independent relationship between HbA1c and coronary artery calcium score progression. RESULTS After adjusting potential confounding factors (age, sex, BMI, height, weight, SBP, DBP, TC, LDL-C, HDL-C, triglycerides, smoking status, alcohol consumption, reflux esophagitis status, hypertension, diabetes, dyslipidemia, ischemic heart disease and cerebrovascular disease), it was revealed that there was a nonlinear relationship between HbA1c and coronary artery calcium score progression, while the scoring point was 5.8%. The effect size was 2.06 to the left of the inflection point, while the 95% CI was 1.85 to 2.29. Whereas, the effect size was 1.04, on the right side of the inflection point while 95% CI was 0.99 to1.10. CONCLUSION The relationship between HbA1c and coronary artery calcium score progression is nonlinear. HbA1c is positively related to coronary artery calcium score progression when HbA1c level was less than 5.8%.
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Affiliation(s)
- Jing Yu
- Department of Medical Imaging, Guizhou Medical University, Guiyang, 550004, Guizhou Province, China
| | - Bo Gao
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou Province, China.
- Key Laboratory of Brain Imaging, Guizhou Medical University, Guiyang, 550004, Guizhou Province, China.
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Sanlialp SC, Sanlialp M. Should We Use Fasting Glucose and the Glycated Hemoglobin (HbA 1c) in Evaluation of Coronary Artery Disease? Angiology 2021; 73:182-183. [PMID: 34142569 DOI: 10.1177/00033197211026418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Musa Sanlialp
- Department of Cardiology, Denizli State Hospital, Denizli, Turkey
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Kayali Y, Ozder A. Glycosylated hemoglobin A1c predicts coronary artery disease in non-diabetic patients. J Clin Lab Anal 2020; 35:e23612. [PMID: 33034919 PMCID: PMC7891500 DOI: 10.1002/jcla.23612] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022] Open
Abstract
Background In primary care, there is a need for simple and cost‐effective tool that will allow the determination of the risk of coronary artery disease (CAD). We aimed to research the value of glycosylated hemoglobin (HbA1c) in the prediction of coronary artery disease. Methods Patients admitted to the outpatient clinic of the Cardiology for angiography were retrospectively screened. Patients with diabetes or with HbA1c of 6.5 or above were excluded. Comparative HbA1c data were obtained according to the stenosis groups. Logistic regression analysis was used to investigate the risk factors affecting stenosis positivity. Results Of the study group, 120 patients were without any stenosis in any coronary artery, 56 patients were with >50% stenosis in one coronary artery, and 71 patients were with >50% stenosis in more than one coronary artery. There was a statistically significant difference between HbA1c measurements according to the degree of stenosis (P = .001 and P < .01, respectively). The odd ratio for HbA1c was 6.260 (95% CI: 3,160‐12,401). According to the stenosis positivity, the cutoff point for HbA1c was found to be 5.6 and above. In the regression analysis, HbA1c was an independent risk factor for CAD. One unit increase in HbA1c level increases the risk of stenosis up to 12.4‐fold (95% CI: 5,990‐25,767). Conclusion The study showed HbA1c can be used as an independent marker in determining the probability and severity of coronary artery disease in non‐diabetic individuals and as a useful marker in primary care predicting CAD.
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Affiliation(s)
- Yildiz Kayali
- Medical Faculty, Department of Family Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Aclan Ozder
- Medical Faculty, Department of Family Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Jannat AM, Shahlavi-Monavvar P. A commentary on the 'glycosylated haemoglobin and coronary atherosclerosis in non-diabetic patients: is it a prognostic factor?'. Acta Cardiol 2018; 73:317. [PMID: 28826345 DOI: 10.1080/00015385.2017.1362092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Abdolkarim Mobasher Jannat
- Department of Medicine, Student Research Committee, Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Karimi-Sari H. Authors' reply on the 'glycosylated haemoglobin and coronary atherosclerosis in non-diabetic patients: is it a prognostic factor?'. Acta Cardiol 2018; 73:214. [PMID: 28974144 DOI: 10.1080/00015385.2017.1384184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hamidreza Karimi-Sari
- Student Research Committee, Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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