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Tsuchida K, Soda S, Rizzo M. The legacy effect in early-stage diabetes: Don't stay by me, cardiovascular disease! J Diabetes Complications 2023; 37:108544. [PMID: 37467599 DOI: 10.1016/j.jdiacomp.2023.108544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/11/2023] [Accepted: 06/11/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Keiichi Tsuchida
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan.
| | - Satoshi Soda
- Department of Endocrinology and Metabolism, Niigata City General Hospital, Niigata, Japan
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, Italy
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Ferrannini G, De Bacquer D, Erlund I, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Schnell O, Tuomilehto J, Vihervaara T, Wood D, Rydén L. Measures of Insulin Resistance as a Screening Tool for Dysglycemia in Patients With Coronary Artery Disease: A Report From the EUROASPIRE V Population. Diabetes Care 2022; 45:2111-2117. [PMID: 35771773 DOI: 10.2337/dc22-0272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The optimal screening strategy for dysglycemia (including type 2 diabetes and impaired glucose tolerance) in patients with coronary artery disease (CAD) is debated. We tested the hypothesis that measures of insulin resistance by HOMA indexes may constitute good screening methods. RESEARCH DESIGN AND METHODS Insulin, C-peptide, glycated hemoglobin A1c, and an oral glucose tolerance test (OGTT) were centrally assessed in 3,534 patients with CAD without known dysglycemia from the fifth European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE V). Three different HOMA indexes were calculated: HOMA of insulin resistance (HOMA-IR), HOMA2 based on insulin (HOMA2-ins), and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycemia was diagnosed based on the 2-h postload glucose value obtained from the OGTT. Information on study participants was obtained by standardized interviews. The optimal thresholds of the three HOMA indexes for dysglycemia diagnosis were obtained by the maximum value of Youden's J statistic on receiver operator characteristic curves. Their correlation with clinical parameters was assessed by Spearman coefficients. RESULTS Of 3,534 patients with CAD (mean age 63 years; 25% women), 41% had dysglycemia. Mean insulin, C-peptide, and HOMA indexes were significantly higher in patients with versus without newly detected dysglycemia (all P < 0.0001). Sensitivity and specificity of the three HOMA indexes for the diagnosis of dysglycemia were low, but their correlation with BMI and waist circumference was strong. CONCLUSIONS Screening for dysglycemia in patients with CAD by HOMA-IR, HOMA2-ins, and HOMA2-Cpep had insufficient diagnostic performance to detect dysglycemia with reference to the yield of an OGTT, which should still be prioritized despite its practical drawbacks.
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Affiliation(s)
- Giulia Ferrannini
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Viveca Gyberg
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Heart & Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Capio St Göran's Hospital, Stockholm, Sweden
| | | | - Jaakko Tuomilehto
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Terhi Vihervaara
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland
| | - Lars Rydén
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Liu J, He LQ, Zhu W, Duan GF, Fang Y, Feng Y, Tian LQ, Zheng QL. Abnormal glucose regulation in Chinese patients with coronary artery disease: a gender analysis. J Cardiothorac Surg 2022; 17:94. [PMID: 35505380 PMCID: PMC9066952 DOI: 10.1186/s13019-022-01848-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes and impaired glucose regulation are very common in patients with coronary artery disease (CAD). In this study, we aim to investigate the prevalence of abnormal glucose regulation in men and women in Chinese CAD patients. METHODS In this retrospective study, 4100 patients (male, n = 2873; female, n = 1227)with CAD were enrolled. The mean age of these patients was 63 years. The demographic data, medical history, echocardiography findings and blood investigations were collected and analyzed. RESULTS In this population, 953 (24%) patients had definite diagnosis of type 2 diabetes mellitus, including 636 males (23%) and 317 females (27%). There was a higher prevalence of diabetes in females than men (p < 0.05). For the remaining patients, 48% (n = 959) undergone an oral glucose tolerance test (OGTT), which revealed that 83 male patients (12%) and 41 female patients (16%) suffered from the type 2 diabetes (p > 0.05). 283 men (40%) and 105 women (41%) had impaired glucose regulation (IGR) (p > 0.05). Only 338 men (25%) and 109 women (19%) showed the normal glucose regulation, implying a higher prevalence of abnormal glucose regulation in females (p < 0.01). The odd ratio (OR) showed that women were more prone to have diabetes mellitus or IGT than men and the OR was 1.44 and 1.43 respectively. CONCLUSION Abnormal glucose regulation is highly prevalent in CAD patients. The women are more prone to have diabetes mellitus or IGT than men.
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Affiliation(s)
- Juan Liu
- Department of Cardiology of Wuhan, No.1 Hospital, No. 215 Zhongshan Avenue, Wuhan, 430022, Hubei Province, China
| | - Li-Qun He
- Department of Cardiology of Wuhan, No.1 Hospital, No. 215 Zhongshan Avenue, Wuhan, 430022, Hubei Province, China
| | - Wei Zhu
- Department of Cardiology of Wuhan, No.1 Hospital, No. 215 Zhongshan Avenue, Wuhan, 430022, Hubei Province, China
| | - Gang-Feng Duan
- Department of Cardiology of Wuhan, No.1 Hospital, No. 215 Zhongshan Avenue, Wuhan, 430022, Hubei Province, China
| | - Yong Fang
- Department of Cardiology of Wuhan, No.1 Hospital, No. 215 Zhongshan Avenue, Wuhan, 430022, Hubei Province, China
| | - Ying Feng
- Department of Cardiology of Wuhan, No.1 Hospital, No. 215 Zhongshan Avenue, Wuhan, 430022, Hubei Province, China
| | - Li-Qun Tian
- Department of Cardiology of Wuhan, No.1 Hospital, No. 215 Zhongshan Avenue, Wuhan, 430022, Hubei Province, China
| | - Qiong-Li Zheng
- Department of Cardiology of Wuhan, No.1 Hospital, No. 215 Zhongshan Avenue, Wuhan, 430022, Hubei Province, China.
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Iswandi CP, van den Berg VJ, Simsek S, van Velzen D, Boekel ET, Cornel JH, de Boer S, de Mulder M, Akkerhuis KM, Boersma E, Umans VA, Kardys I. IGF-1 is not related to long-term outcome in hyperglycemic acute coronary syndrome patients. Diab Vasc Dis Res 2021; 18:14791641211047436. [PMID: 34851758 PMCID: PMC8743970 DOI: 10.1177/14791641211047436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Insulin-like growth factor-1 (IGF-1) has been associated with both protective and detrimental effects on the development of ischemic heart disease. The relationship between IGF-1 levels and major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS) patients remains unclear. This study aimed to investigate the relationship between IGF-1 admission levels in hyperglycemic ACS patients and: (1) MACE over a 5 years follow-up, (2) type 2 diabetes at discharge, and (3) post-ACS myocardial infarct size and dysfunction. METHODS This was a post hoc analysis of the BIOMArCS-2 randomized controlled trial. From July 2008 to February 2012, 276 ACS patients with admission plasma glucose level between 140 and 288 mg/dL were included. Records of the composite of all-cause mortality and recurrent non-fatal myocardial infarction were obtained during 5 years follow-up. Venous blood samples were collected on admission. IGF-1 was measured batchwise after study completion. Oral glucose tolerance test was performed to diagnose type 2 diabetes, whereas infarct size and left ventricular function were assessed by myocardial perfusion scintigraphy (MPS) imaging, 6 weeks post-ACS. RESULTS Cumulative incidence of MACE was 24% at 5 years follow-up. IGF-1 was not independently associated with MACE (HR:1.00 (95%CI:0.99-1.00), p = 0.29). Seventy-eight patients (28%) had type 2 diabetes at discharge, and the highest quartile of IGF-1 levels was associated with the lowest incidence of diabetes (HR:0.40 (95%CI:0.17-0.95), p = 0.037). IGF-1 levels were not associated with post-ACS myocardial infarct size and dysfunction. CONCLUSIONS IGF-1 carries potential for predicting type 2 diabetes, rather than long-term cardiovascular outcomes and post-ACS myocardial infarct size and dysfunction, in hyperglycemic ACS patients.
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Affiliation(s)
- Cindya P Iswandi
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Victor J van den Berg
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, Netherlands
| | - Daan van Velzen
- Department of Internal Medicine, Northwest Clinics, Alkmaar, Netherlands
| | - Edwin Ten Boekel
- Department of Clinical Chemistry, Northwest Clinics, Alkmaar, Netherlands
| | - Jan-Hein Cornel
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Sanneke de Boer
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Maarten de Mulder
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Victor A Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based cohort study. J Transl Med 2021; 19:277. [PMID: 34193200 PMCID: PMC8243871 DOI: 10.1186/s12967-021-02950-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background Fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2 h-PCPG), whether as continuous or categorical variables, are associated with incident cardiovascular disease (CVD) and diabetes; however, their role among patients with existing CVD is a matter of debate. We aimed to evaluate associations of different glucose intolerance states with recurrent CVD and incident diabetes among subjects with previous CVD. Methods From a prospective population-based cohort, 408 Iranians aged ≥ 30 years, with history of CVD and without known diabetes were included. Associations of impaired fasting glucose (IFG) according to the American Diabetes Association (ADA) and World Health Organization (WHO) criteria, impaired glucose tolerance (IGT), newly diagnosed diabetes (NDM) with outcomes of interest were determined by multivariable Cox proportional hazard models after adjustment for traditional risk factors. Furthermore, FPG and 2 h-PCPG were entered as continuous variables. Results Over a decade of follow-up, 220 CVD events including 89 hard events (death, myocardial infarction and stroke) occurred. Regarding prediabetes, only IFG-ADA was associated with increased risk of hard CVD [hazard ratio(HR), 95%CI: 1.62,1.03–2.57] in the age-sex adjusted model. In patients with NDM, those with FPG ≥ 7 mmol/L were at higher risk of incident CVD/coronary heart disease(CHD) and their related hard outcomes (HR ranged from 1.89 to 2.84, all P < 0.05). Moreover, those with 2 h-PCPG ≥ 11.1 mmol/L had significant higher risk of CVD (1.46,1.02–2.11), CHD (1.46,1.00–2.15) and hard CHD (1.95:0.99–3.85, P = 0.05). In the fully adjusted model, each 1 SD increase in FPG was associated with 20, 27, 15 and 25% higher risk of CVD, hard CVD, CHD and hard CHD, respectively; moreover each 1 SD higher 2 h-PCPG was associated with 21% and 16% higher risk of CVD, and CHD, respectively. Among individuals free of diabetes at baseline (n = 361), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes (all P < 0.05); significant associations were also found for FPG and 2 h-PCPG as continuous variables (all HRs for 1-SD increase > 2, P < 0.05). Conclusions Among subjects with stable CVD, NDM whether as high FPG or 2 h-PCPG, but not pre-diabetes status was significantly associated with CVD/CHD and related hard outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-02950-y.
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Chattopadhyay S, George A, John J, Sathyapalan T. Postload glucose spike but not fasting glucose determines prognosis after myocardial infarction in patients without known or newly diagnosed diabetes. J Diabetes 2021; 13:191-199. [PMID: 32910560 DOI: 10.1111/1753-0407.13111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The effect of postload glucose spikes (PGS), the difference between 2 hour post-load plasma glucose (2hPLPG) and fasting plasma glucose (FPG), on post-myocardial infarction (post-MI) prognosis in nondiabetic patients is unexplored. METHODS This is a retrospective cohort analysis of 847 nondiabetic post-MI survivors who underwent a predischarge oral glucose tolerance test (median PGS: 2.4 mmol/L). Patients were divided into the unmatched groups 1 and 2 (PGS ≤ and > 2.4 mmol/L) and the propensity score-matched groups 1M and 2M (355 pairs assembled from the overall cohort), and these groups were compared. Major adverse cardiac events (MACE: death and nonfatal reinfarction) were recorded during follow-up (median: 3.4 years). Event-free survival was compared by the Kaplan-Meier method. Multivariate Cox proportional hazards regression determined the predictors of MACE. C-statistics (change in area under the curve, δAUC), continuous net reclassification improvement (NRI>0 ), and integrated discrimination improvement (IDI) were used to compare models. RESULTS The number of MACE was higher in groups 2 (27.3% vs 14.2%, P < .001) and 2M (24.5% vs 15.5%, P < .001). Event-free survival was worse in groups 2 (hazard ratio [HR] 2.01; 95% CI, 1.49-2.71; P < .001) and 2M (HR 1.63; 95% CI, 1.17-2.27; P = .004). PGS independently predicted MACE-free survival in the whole (HR 1.16; 95% CI, 1.06-1.26; P = .002) and matched cohort (HR 1.12; 95% CI, 1.02-1.24; P = .021). PGS, but not FPG or 2hPPG, improved the predictive performance of the base model (δAUC 0.013, P = .046), with greater improvement seen when PGS was added and compared to 2hPPG (δAUC 0.005, P = .034; NRI>0 0.2107, P = .013; IDI 0.0042, P = .046). CONCLUSION PGS is a better predictor of post-MI prognosis than 2hPPG in nondiabetic patients.
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Affiliation(s)
| | - Anish George
- Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, UK
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, UK
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, UK
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Chattopadhyay S, George A, John J, Sathyapalan T. Newly diagnosed abnormal glucose tolerance determines post-MI prognosis in patients with hospital related hyperglycaemia but without known diabetes. J Diabetes Complications 2020; 34:107518. [PMID: 31924528 DOI: 10.1016/j.jdiacomp.2019.107518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/20/2019] [Accepted: 12/28/2019] [Indexed: 01/16/2023]
Abstract
AIMS Investigate if abnormal glucose tolerance (AGT) affects post-myocardial infarction (MI) prognosis in patients with hospital-related hyperglycaemia (HRH) but without known diabetes mellitus (KDM). METHODS Post-MI survivors without KDM underwent pre-discharge oral glucose tolerance test. Cardiovascular death and non-fatal re-infarction (MACE) were recorded. We compare the ability of admission (APG), fasting (FPG) and 2 h post-load (2 h-PG) plasma glucose to predict MACE in patients with (HRH) and without HRH (NoHRH). RESULTS 50.2% and 73% of NoHRH and HRH had AGT respectively. MACE occurred in 19.5% and 18.1% in HRH and NoHRH groups. MACE-free survival was lower in patient with AGT in both groups (NoHRH: HR 1.82, 95% CI 1.19-2.78, p = 0.005; HRH: HR 2.48, 95% CI 1.24-4.96, p = 0.010). AGT predicted MACE-free survival (NoHRH: HR 1.60, 95% CI 1.02-2.51, p = 0.042; HRH: HR 3.09, 95% CI 1.07-8.94, p = 0.037). 2 h-PG, but not FPG or APG, independently predicted MACE free survival (NoHRH: HR 1.17, 95% CI 1.07-1.27, p ≤0.001 and HRH: HR 1.18, 95% CI 1.03-1.37, p = 0.020). Addition of AGT and 2 h-PG, not FPG or APG, improved net reclassification of events in both groups. CONCLUSION Post-MI prognosis is worse with AGT irrespective of presence of HRH. 2 h-PG, predicts prognosis in HRH and NoHRH groups.
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Affiliation(s)
| | - Anish George
- Department of Cardiology, Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, UK
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, UK.
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, UK.
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Tsuchida K, Mitsuma W, Sato Y, Ozaki K, Soda S, Hatada K, Tanaka K, Hosaka Y, Imai S, Takahashi K, Matsubara T, Oda H. Impaired glucose tolerance and future cardiovascular risk after coronary revascularization: a 10-year follow-up report. Acta Diabetol 2020; 57:173-182. [PMID: 31375898 DOI: 10.1007/s00592-019-01394-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/25/2019] [Indexed: 01/21/2023]
Abstract
AIMS Practical management guidelines for impaired glucose tolerance (IGT) have not been established. Although IGT is a potent marker of cardiovascular disease (CVD), it is still controversial whether its magnitude of CVD risk is comparable to that of frank diabetes. Moreover, information on long-term clinical outcomes of IGT patients undergoing coronary revascularization is limited. The aim of the present work was to investigate the 10-year prognostic impact of IGT in comparison with diabetes in patients with CAD undergoing coronary revascularization. METHODS This cohort recruited from two Japanese clinical sites included patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) between 2004 and 2008. Patients were categorized into previously known diabetes (PKD, n = 197), newly diagnosed diabetes (NDD, n = 51), and IGT (n = 50) groups according to oral glucose tolerance test results except for PKD. The primary end point was defined as a composite of cardiovascular death, myocardial infarction, stroke, repeat revascularization, and heart failure hospitalization. RESULTS The cumulative risk of the primary outcome was significantly higher in the PKD and IGT than in the NDD (log-rank test p = 0.017). A Cox proportional hazards model demonstrated that IGT (hazard ratio [HR], 7.91; 95% confidence interval [CI], 1.84-27.58) and creatinine clearance (HR, 7.89, 95% CI, 2.73-19.10) were predictors of long-term CVD risk, while NDD and PKD were not. CONCLUSIONS IGT significantly increased the long-term risk of developing CVD in patients with CAD after PCI compared with diabetes.
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Affiliation(s)
- Keiichi Tsuchida
- Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan.
| | - Wataru Mitsuma
- Division of Cardiology, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuyuki Ozaki
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 757 Ichibancho, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Satoshi Soda
- Department of Endocrinology and Metabolism, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Katsuharu Hatada
- Division of Cardiology, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan
| | - Komei Tanaka
- Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Yukio Hosaka
- Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Shunsuke Imai
- Division of Cardiology, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan
| | - Kazuyoshi Takahashi
- Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Taku Matsubara
- Division of Cardiology, Shinrakuen Hospital, 3-3-11 Shindori-minami, Nishi-ku, Niigata, 950-2087, Japan
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
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Chattopadhyay S, George A, John J, Sathyapalan T. Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes. Diab Vasc Dis Res 2019; 16:489-497. [PMID: 31044609 DOI: 10.1177/1479164119845561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Effect of pre-diabetes mellitus on post-myocardial infarction prognosis is unclear. METHODS Retrospective cohort analysis of 1056 myocardial infarction survivors with fasting plasma glucose and 2-h post-load plasma glucose measured. Major adverse cardiovascular events included death, non-fatal reinfarction and ischaemic stroke. Cox proportional hazard regression identified predictors of event-free survival. Continuous net reclassification improvement and integrated discrimination improvement determined the added predictive value of glycaemic indices. RESULTS Major adverse cardiovascular events occurred in 25.1% and 16.4% patients with and without pre-diabetes mellitus (hazard ratio with pre-diabetes mellitus: 1.56; 95% confidence interval: 1.17-2.08; p = 0.003) in the whole cohort and in 24.1% and 17.2% patients (hazard ratio with pre-diabetes mellitus, 1.43; 95% confidence interval: 1.03-1.98; p = 0.033) in the matched cohort, respectively. Pre-diabetes mellitus predicted major adverse cardiovascular events-free survival in whole (hazard ratio: 1.39; 95% confidence interval: 1.03-1.89; p = 0.033) and matched cohorts (hazard ratio: 1.42; 95% confidence interval: 1.01-1.99; p = 0.043). The 2-h post-load plasma glucose, but not fasting plasma glucose, predicted major adverse cardiovascular events-free survival in the whole (hazard ratio: 1.16; 95% confidence interval: 1.07-1.26; p < 0.0001) and matched cohorts (hazard ratio: 1.20; 95% confidence interval: 1.09-1.31; p < 0.0001). Adding 2-h post-load plasma glucose to models containing fasting plasma glucose, significantly improved net reclassification improvement and integrated discrimination improvement for both cohorts, but not vice versa. CONCLUSION Pre-diabetes mellitus predicts major adverse cardiovascular events after myocardial infarction. The 2-h post-load plasma glucose predicts prognosis better than fasting plasma glucose in these patients.
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Affiliation(s)
| | - Anish George
- Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, UK
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Cottingham, UK
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Hull, UK
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Velders MA, Calais F, Dahle N, Fall T, Hagström E, Leppert J, Nowak C, Tenerz Å, Ärnlöv J, Hedberg P. Cathepsin D improves the prediction of undetected diabetes in patients with myocardial infarction. Ups J Med Sci 2019; 124:187-192. [PMID: 31429631 PMCID: PMC7182365 DOI: 10.1080/03009734.2019.1650141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Newer therapeutic agents for type 2 diabetes mellitus can improve cardiovascular outcomes, but diabetes remains underdiagnosed in patients with myocardial infarction (MI). We sought to identify proteomic markers of undetected dysglycaemia (impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus) to improve the identification of patients at highest risk for diabetes. Materials and methods: In this prospective cohort, 626 patients without known diabetes underwent oral glucose tolerance testing (OGTT) during admission for MI. Proximity extension assay was used to measure 81 biomarkers. Multivariable logistic regression, adjusting for risk factors, was used to evaluate the association of biomarkers with dysglycaemia. Subsequently, lasso regression was performed in a 2/3 training set to identify proteomic biomarkers with prognostic value for dysglycaemia, when added to risk factors, fasting plasma glucose, and glycated haemoglobin A1c. Determination of discriminatory ability was performed in a 1/3 test set. Results: In total, 401/626 patients (64.1%) met the criteria for dysglycaemia. Using multivariable logistic regression, cathepsin D had the strongest association with dysglycaemia. Lasso regression selected seven markers, including cathepsin D, that improved prediction of dysglycaemia (area under the receiver operator curve [AUC] 0.848 increased to 0.863). In patients with normal fasting plasma glucose, only cathepsin D was selected (AUC 0.699 increased to 0.704). Conclusions: Newly detected dysglycaemia, including manifest diabetes, is common in patients with acute MI. Cathepsin D improved the prediction of dysglycaemia, which may be helpful in the a priori risk determination of diabetes as a motivation for confirmatory OGTT.
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Affiliation(s)
- Matthijs A. Velders
- Department of Medicine, Västmanland County Hospital, Västerås, Sweden
- CONTACT Matthijs Velders Department of Medicine, Västmanland County Hospital, Sigtunagatan, 721 89 Västerås, Sweden
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Nina Dahle
- Centre for Clinical Research, Uppsala University, Falun, Dalarna, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and SciLife Laboratory, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Molecular Epidemiology and SciLife Laboratory, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Jerzy Leppert
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Christoph Nowak
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
| | - Åke Tenerz
- Department of Medicine, Västmanland County Hospital, Västerås, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Pär Hedberg
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
- Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden
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Mann BK, Bhandohal JS, Hong J. An Overall Glance of Evidence Supportive of One-Hour and Two-Hour Postload Plasma Glucose Levels as Predictors of Long-Term Cardiovascular Events. Int J Endocrinol 2019; 2019:6048954. [PMID: 31929794 PMCID: PMC6935819 DOI: 10.1155/2019/6048954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/28/2019] [Indexed: 12/26/2022] Open
Abstract
This review summarizes the vast literature describing the long-term epidemiological studies with emphasis on postprandial glucose as a stronger predictor of cardiovascular complications as compared to fasting glucose and HbA1c. Many molecular studies also supported this fact by illustrating that postchallenge hyperglycemia is associated with elevated biomarkers of systemic inflammation in the plasma and thus increasing the chances of vascular damage. Large-scale studies have proved that vascular stiffness, brachial-ankle pulse-wave velocity, carotid intima thickness, and left ventricular hypertrophy have been associated with postprandial glucose as compared to fasting glucose or glycosylated hemoglobin.
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Affiliation(s)
- Baldeep K. Mann
- New York City Health and Hospitals/Metropolitan Hospital Center, New York, NY, USA
| | | | - Jungrak Hong
- New York City Health and Hospitals/Metropolitan Hospital Center, New York, NY, USA
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12
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Stacey RB, Zgibor J, Leaverton PE, Schocken DD, Peregoy JA, Lyles MF, Bertoni AG, Burke GL. Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort. J Am Geriatr Soc 2018; 67:43-49. [PMID: 30298627 DOI: 10.1111/jgs.15604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/29/2018] [Accepted: 08/06/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate glucose levels as a risk factor for unrecognized myocardial infarctions (UMIs). DESIGN Cohort SETTING: Cardiovascular Health Study. PARTICIPANTS Individuals aged 65 and older with fasting glucose measurements (N=4,355; normal fasting glucose (NFG), n = 2,041; impaired fasting glucose (IFG), n = 1,706; DM: n = 608; 40% male, 84% white, mean age 72.4 ± 5.6). MEASUREMENTS The relationship between glucose levels and UMI was examined. Participants with prior coronary heart disease (CHD) or UMI on initial electrocardiography were excluded. Using Minnesota codes, UMI was identified according to the presence of pathological Q-waves or minor Q-waves with ST-T abnormalities. Crude and adjusted hazard ratios (HRs) were calculated. Analyses were adjusted for age, sex, body mass index (BMI), hypertension, antihypertensive and lipid-lowering medication use, total cholesterol, high-density lipoprotein cholesterol, and smoking status. RESULTS Over a mean follow-up of 6 years, there were 459 incident UMIs (NFG, n=202; IFG, n=183; DM, n=74). Participants with IFG were slightly more likely than those with NFG to experience a UMI (hazard ratio (HR)=1.11, 95% confidence interval (CI)=0.91-1.36, p = .30), and those with DM were more likely than those with NFG to experience a UMI (HR=1.65, 95% CI=1.25-2.13, p < .001). After adjustment HR for UMI in IFG those with IFG were no more likely than those with NFG to experience a UMI (HR=1.01, 95% CI=0.82-1.24, p = .93), whereas those with DM were more likely than those with NFG to experience a UMI (HR=1.37, 95% CI=1.02-1.81, p = .03). The 2-hour oral glucose tolerance test was not statistically significantly associated with UMI. CONCLUSION Fasting glucose status, particularly in the diabetic range, forecasted UMI during 6 years of follow-up in elderly adults. Further studies are needed to clarify the level of glucose at which risk is greater. J Am Geriatr Soc 67:43-49, 2019.
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Affiliation(s)
- Richard Brandon Stacey
- Section on Cardiology, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Janice Zgibor
- Department of Epidemiology and Biostatistics, College of Public Health University of South Florida, Tampa, Florida
| | - Paul E Leaverton
- Department of Epidemiology and Biostatistics, College of Public Health University of South Florida, Tampa, Florida
| | - Douglas D Schocken
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jennifer A Peregoy
- Department of Epidemiology and Biostatistics, College of Public Health University of South Florida, Tampa, Florida
| | - Mary F Lyles
- Departments of Gerontology, School of Medicine Wake Forest University, Winston-Salem, North Carolina
| | - Alain G Bertoni
- Department of Public Health Sciences, School of Medicine Wake Forest University, Winston-Salem, North Carolina
| | - Gregory L Burke
- Department of Public Health Sciences, School of Medicine Wake Forest University, Winston-Salem, North Carolina
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13
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The Impact of Glyco-Metabolic Status in Patients Treated for Acute Coronary Syndrome. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2018; 39:37-50. [PMID: 30110257 DOI: 10.2478/prilozi-2018-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Objective: The aim of the study was to assess the prevalence of newly diagnosed diabetes in patients with acute coronary syndrome and estimate the relationship between stress hyperglycemia, glyco-regulation and newly diagnosed diabetes with hospital morbidity and mortality.
Methods: This was an observational study which included all patients hospitalized due to acute coronary syndrome (January 2015 until April 2017) at the University Clinic of Cardiology in Skopje, Macedonia. We analyzed demographic, clinical, biochemical variables and hospital morbidity and mortality. Five investigated groups were compared using a single biochemical parameter glycated hemoglobin (HgbA1c) depending on the presence of known diabetes before the acute event: 0-without DM (HgbA1c <5.6%), 1-newly diagnosed pre-diabetes (HgbA1c 5.6-6.5%), 2-newly diagnosed diabetes (HgbA1c ≥ 6.5%), 3-known well controlled diabetes (HgbA1c <7%) and 4-known un-controlled diabetes (HgbA1c ≥7%).
Results: 860 patients were analyzed. Impaired glucose metabolism was confirmed in 35% of patients, 9% of which were with newly diagnosed diabetes. Stress hyperglycemia was reported in 27.3% (3.6% were without diabetes). The highest values of stress hyperglycemia were reported in newly diagnosed and known un-controlled diabetes. In-hospital morbidity and mortality were 15% and 5% accordingly and the rate was highest in patients with newly diagnosed and known, but un-controlled diabetes. HgbA1c, stress hyperglycemia, and poor glycemic control have emerged as significant independent predictors of hospital morbidity and mortality in patients with acute coronary syndrome.
Conclusion: High prevalence of newly diagnosed diabetes was observed in patients with acute coronary syndrome. Stress hyperglycemia and failure to achieve glycemic control are independent predictors of hospital morbidity and mortality.
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Chattopadhyay S, George A, John J, Sathyapalan T. Two-hour post-challenge glucose is a better predictor of adverse outcome after myocardial infarction than fasting or admission glucose in patients without diabetes. Acta Diabetol 2018; 55:449-458. [PMID: 29450734 DOI: 10.1007/s00592-018-1114-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 02/05/2018] [Indexed: 11/26/2022]
Abstract
AIMS We evaluate prevalence of new abnormal glucose tolerance (AGT) in post-MI survivors without known diabetes (DM) if guidelines are followed and compare the ability of admission (APG), fasting (FPG) and 2-h post-load plasma glucose (2h-PG) to predict prognosis. METHODS A total of 674 patients were followed up for 4 years for incidence of major adverse cardiovascular events (MACE) of cardiovascular death, non-fatal re-infarction or non-haemorrhagic stroke. Ability of models including APG, FPG and 2h-PG to predict MACE was compared. RESULTS Of the total, 93-96% of impaired glucose tolerance and 64-75% of DM would be missed with current guidelines. MACE was higher in the upper quartiles of 2h-PG. When 2h-PG and FPG were included simultaneously in models, only 2h-PG predicted MACE (HR 1.12, CI 1.04-1.20, p = 0.0012), all cause mortality (HR 1.17, CI 1.05-1.30, p = 0.0039), cardiovascular mortality (HR 1.17, CI 1.02-1.33, p = 0.0205) and non-fatal MI (HR 1.10, CI 1.01-1.20, p = 0.0291). Adding 2h-PG significantly improved ability of models including FPG (χ2 = 16.01, df = 1, p = 0.0001) or FPG and APG (χ2 = 17.36, df = 1, p = 0.000) to predict MACE. Model including 2h-PG only had the lowest Akaike's information criteria and highest Akaike weights suggesting that this was the best in predicting events. Adding 2h-PG to models including FPG or APG with other co-variates yielded continuous net reclassification improvement (NRI) of 0.22 (p = 0.026) and 0.27 (p = 0.005) and categorical NRI of 0.09 (p = 0.032) and 0.12 (p = 0.014), respectively. Adding 2 h-PG to models including only FPG, only APG and both yielded integrated discrimination improvement of 0.012 (p = 0.015), 0.022 (p = 0.001) and 0.013 (p = 0.014), respectively. CONCLUSIONS AGT is under-diagnosed on current guidelines. 2h-PG is a better predictor of prognosis compared to APG and FPG.
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Affiliation(s)
- Sudipta Chattopadhyay
- Department of Cardiology, Milton Keynes University Hospital, Standing Way, Milton Keynes, MK6 5LD, UK.
| | - Anish George
- Department of Cardiology, Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, UK
| | - Joseph John
- Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, UK
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, UK
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15
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Pararajasingam G, Høfsten DE, Løgstrup BB, Egstrup M, Henriksen FL, Hangaard J, Egstrup K. Newly detected abnormal glucose regulation and long-term prognosis after acute myocardial infarction: Comparison of an oral glucose tolerance test and glycosylated haemoglobin A1c. Int J Cardiol 2016; 214:310-5. [PMID: 27085117 DOI: 10.1016/j.ijcard.2016.03.199] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 02/29/2016] [Accepted: 03/29/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND An oral glucose tolerance test (OGTT) and/or glycosylated haemoglobin A1c (HbA1c) in patients with acute myocardial infarction (AMI) identify patients with increased mortality risk, but no comparison of the long-term prognostic values has yet been investigated. METHODS This study was a prospective cohort enrolling patients with AMI between 2002 until 2008 and follow-up until 1st October, 2012. Patients without known diabetes mellitus (DM) underwent an OGTT. Seventy-nine patients with known DM did not have an OGTT performed. Primary endpoint was all-cause mortality. We included 548 patients with AMI, of whom 469 underwent a standardized OGTT and were stratified according to OGTT and HbA1c. RESULTS During 9.8years of follow-up, 179 (33%) patients died. In patients having increased HbA1c ≥6.5%, a significantly increased mortality was observed (Hazard Ratio (HR) 1.60 [1.09-2.34]). However, when adjusting for known DM, no significance was detected. An OGTT did not show a significantly increased mortality, if used separately. A combined estimate showed a significantly increased mortality in patients categorized as newly diagnosed DM by OGTT and HbA1c<6.5% (HR 1.56 [95% CI 1.07-2.30]) compared to patients categorized as normal/impaired fasting glycaemia/impaired glucose tolerance by OGTT and HbA1c <6.5%. Approximately 50% of the patients with newly diagnosed DM by OGTT were only detected due to 2-hour post-load glucose values. CONCLUSION An OGTT is recommended in AMI patients without known DM and HbA1c<6.5%. Patients categorized as newly diagnosed DM by OGTT although HbA1c <6.5% share the same high risk of mortality as patients with HbA1c≥6.5%.
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Affiliation(s)
- Gokulan Pararajasingam
- Department of Medical Research, OUH Svendborg Hospital, Valdemarsgade 53, 5700 Svendborg, Denmark.
| | - Dan Eik Høfsten
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Brian Bridal Løgstrup
- Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Michael Egstrup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Finn Lund Henriksen
- Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Jørgen Hangaard
- Department of Endocrinology, OUH Svendborg Hospital, Valdemarsgade 53, 5700 Svendborg, Denmark
| | - Kenneth Egstrup
- Department of Medical Research, OUH Svendborg Hospital, Valdemarsgade 53, 5700 Svendborg, Denmark
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Yun P, Du AM, Chen XJ, Liu JC, Xiao H. Effect of Acarbose on Long-Term Prognosis in Acute Coronary Syndromes Patients with Newly Diagnosed Impaired Glucose Tolerance. J Diabetes Res 2016; 2016:1602083. [PMID: 26770983 PMCID: PMC4684859 DOI: 10.1155/2016/1602083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/30/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To investigate the effect of acarbose therapy on the long-term prognosis of patients with acute coronary syndromes (ACS) complicating newly diagnosed impaired glucose tolerance (IGT). METHODOLOGY 135 patients hospitalized for ACS who had been newly diagnosed with IGT were randomly assigned to acarbose group (150 mg/day, n = 67) or control group (no acarbose, n = 68). All cases in each group were given the same elementary treatment. Mean follow-up was 2.3 years. The incidence of major adverse cardiovascular event (MACE) and carotid intima-middle thickness (CIMT) were statistically analyzed. RESULTS During the mean follow-up of 2.3 years, the risk of recurrent MACE in acarbose group was decreased significantly compared with that in control group (26.67% versus 46.88%, P < 0.05); at the same time, thickening of the CIMT was significantly slower than the control group ((1.28 ± 0.42) mm versus (1.51 ± 0.64) mm, P < 0.05). CONCLUSIONS Acarbose can effectively reduce the risk of MACE in ACS patients with newly diagnosed IGT, simultaneously retarding the progression of carotid intima-media thickness.
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Affiliation(s)
- Peng Yun
- Department of Internal Medicine, School of Clinical Medicine, Yangtze University, Jingzhou, Hubei 434000, China
| | - Ai-ming Du
- Department of Cardiology, Central Hospital of Jingzhou City, Hubei 434001, China
| | - Xue-jun Chen
- Department of Cardiology, Central Hospital of Jingzhou City, Hubei 434001, China
| | - Jing-cheng Liu
- Department of Endocrinology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, China
| | - Hu Xiao
- Department of Endocrinology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, China
- *Hu Xiao:
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17
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Prediabetes and the association with unrecognized myocardial infarction in the multi-ethnic study of atherosclerosis. Am Heart J 2015; 170:923-8. [PMID: 26542500 DOI: 10.1016/j.ahj.2015.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/05/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND With one-quarter of initial myocardial infarctions (MI) being unrecognized MI (UMI), recognition is critical to minimize further cardiovascular risk. Diabetes mellitus is an established risk factor for UMI. If impaired fasting glucose (IFG) also increased the risk for UMI, it would represent a significant public health challenge due to the rapid worldwide increase in IFG prevalence. We compared participants with IFG to those with normal fasting glucose (NFG) to determine if IFG was associated with UMIs. METHODS We performed cross-sectional analyses from the MESA, a population-based cohort study. There were 6,814 participants recruited during July 2000 to September 2002 from the general community at 6 field sites. After excluding those with diabetes mellitus or missing variables, 5,885 participants were included. At baseline, there were 4,955 participants with NFG and 930 participants with IFG. The main outcome was an UMI defined by the presence of pathological Q waves or minor Q waves with ST-T abnormalities on initial 12-lead electrocardiogram. Logistic regression was used to generate crude ORs and adjust for covariates. RESULTS There was a higher prevalence of UMI in those with IFG compared with those with NFG [3.5% (n = 72) vs 1.4% (n = 30)]. After adjustment for multiple risk factors, there was a higher odds of an UMI among those with IFG compared with those with NFG [OR: 1.60 (95% CI: 1.0-2.5); P = .048]. CONCLUSIONS Impaired fasting glucose is associated with unrecognized myocardial infarctions in a multi-ethnic population free of baseline cardiovascular disease.
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18
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Lee YH, Armstrong EJ, Kim G, Oh J, Kang SM, Lee BW, Ahn CW, Cha BS, Lee HC, Mantzoros CS, Kang ES. Undiagnosed diabetes is prevalent in younger adults and associated with a higher risk cardiometabolic profile compared to diagnosed diabetes. Am Heart J 2015; 170:760-769.e2. [PMID: 26386800 DOI: 10.1016/j.ahj.2015.07.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND A substantial percentage of patients have undiagnosed diabetes. We investigated the demographic characteristics and cardiometabolic profiles of subjects with undiagnosed diabetes. METHODS A cross-sectional study with nationally representative samples of 25490 subjects aged ≥ 20 years from the KHNANES 2008 to 2011, which applied a complex, multistage, probability proportional to size sampling design. Subjects were categorized as having normal glucose (n = 16880), impaired fasting glucose (n = 5771), undiagnosed diabetes (n = 713), or diagnosed diabetes (n = 2126). Hyper low-density lipoprotein cholesterolemia was individually evaluated by the 2004 Adult Treatment Panel III guidelines and predicted risk of cardiovascular disease was estimated from the Framingham model. RESULTS Among overall subjects with diabetes, the prevalence of undiagnosed diabetes was markedly increased in younger adults compared to older adults (49% in diabetic subjects <50 years vs 23% in diabetic subjects ≥50 years, P < .001), suggesting significant discrepancies in age-based screening. Patients with undiagnosed diabetes were also more likely to have undiagnosed or uncontrolled hypertension and hyper-low-density lipoprotein cholesterolemia. Individuals with undiagnosed diabetes had a significantly higher predicted 10-year Framingham cardiovascular disease risk than those with diagnosed diabetes (11% vs 8% in <50 years, 33% vs 30% in ≥50 years; both P < .001). Patients with undiagnosed diabetes were also more likely to have multiple cardiovascular risk factors including obesity, smoking and uncontrolled hypertension. CONCLUSIONS People with undiagnosed diabetes have a higher predicted risk for cardiovascular disease compared to those with diagnosed diabetes. Intensive screening for diabetes in younger adults should be stressed in public healthcare to reduce the burden of modifiable cardiometabolic risk among individuals with undiagnosed diabetes.
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Kuhl J, Jörneskog G, Wemminger M, Bengtsson M, Lundman P, Kalani M. Long-term clinical outcome in patients with acute coronary syndrome and dysglycaemia. Cardiovasc Diabetol 2015; 14:120. [PMID: 26382578 PMCID: PMC4574088 DOI: 10.1186/s12933-015-0283-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/03/2015] [Indexed: 11/10/2022] Open
Abstract
Background Diabetes and impaired glucose tolerance (IGT) are major risk factors for atherosclerosis including coronary artery disease (CAD). The present study’s aim was to investigate the importance of glucose tolerance for long-term clinical outcome in patients with acute coronary syndrome (ACS). Methods A total 1062 consecutive patients, 781 men and 281 women, aged 32–80 years, admitted to the coronary care unit at Danderyd University Hospital, Stockholm, for ACS from 2006 to 2008 were included. At discharge, the patients were categorized according to an oral glucose tolerance test (OGTT) as having normal glucose tolerance (NGT), n = 295 (28 %); impaired fasting glucose (IFG) and IGT, n = 299 (28 %); diabetes discovered by OGTT, n = 156 (15 %); or known diabetes at admission, n = 312 (29 %). Mortality and reinfarction rates were studied during a mean follow-up time of 4.0 (±0.8) years. Clinical outcome data were obtained from the Swedish Coronary Angiography and Angioplasty Registry and the Swedish National Registry. Results There was significantly higher (p < 0.001) mortality within, 30 days, 1 and 3 years in patients with known diabetes as compared to the other groups. During the follow-up, 86 patients (28 %) with known diabetes had reinfarction as compared to 36 patients (12 %) with NGT and 79 patients (17 %) with dysglycaemia (IFG, IGT and diabetes) discovered by OGTT. Conclusion A majority (72 % in this study) of patients admitted for ACS have disturbed glucose metabolism, including diabetes, with high prevalence of previously undiagnosed dysglycaemia. Both patients with known diabetes and dysglycaemia discovered by OGTT show a high risk for poor clinical prognosis.
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Affiliation(s)
- Jeanette Kuhl
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. .,Department of Medicine, Karolinska Institutet, Karolinska University Hospital, 182 88, Stockholm, Sweden.
| | - Gun Jörneskog
- Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
| | - Malin Wemminger
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
| | - Mattias Bengtsson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
| | - Pia Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
| | - Majid Kalani
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
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Gómez-Ambrosi J, Catalán V, Rodríguez A, Andrada P, Ramírez B, Ibáñez P, Vila N, Romero S, Margall MA, Gil MJ, Moncada R, Valentí V, Silva C, Salvador J, Frühbeck G. Increased cardiometabolic risk factors and inflammation in adipose tissue in obese subjects classified as metabolically healthy. Diabetes Care 2014; 37:2813-21. [PMID: 25011950 DOI: 10.2337/dc14-0937] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It has been suggested that individuals with the condition known as metabolically healthy obesity (MHO) may not have the same increased risk for the development of metabolic abnormalities as their non-metabolically healthy counterparts. However, the validity of this concept has recently been challenged, since it may not translate into lower morbidity and mortality. The aim of the current study was to compare the cardiometabolic/inflammatory profile and the prevalence of impaired glucose tolerance (IGT) and type 2 diabetes (T2D) in patients categorized as having MHO or metabolically abnormal obesity (MAO). RESEARCH DESIGN AND METHODS We performed a cross-sectional analysis to compare the cardiometabolic/inflammatory profile of 222 MHO and 222 MAO patients (62% women) matched by age, including 255 lean subjects as reference (cohort 1). In a second cohort, we analyzed the adipokine profile and the expression of genes involved in inflammation and extracellular matrix remodeling in visceral adipose tissue (VAT; n = 82) and liver (n = 55). RESULTS The cardiometabolic and inflammatory profiles (CRP, fibrinogen, uric acid, leukocyte count, and hepatic enzymes) were similarly increased in MHO and MAO in both cohorts. Moreover, above 30%of patients classified as MHO according to fasting plasma glucose exhibited IGT or T2D [corrected]. The profile of classic (leptin, adiponectin, resistin) as well as novel (serum amyloid A and matrix metallopeptidase 9) adipokines was almost identical in MHO and MAO groups in cohort 2. Expression of genes involved in inflammation and tissue remodeling in VAT and liver showed a similar alteration pattern in MHO and MAO individuals. CONCLUSIONS The current study provides evidence for the existence of a comparable adverse cardiometabolic profile in MHO and MAO patients; thus the MHO concept should be applied with caution. A better identification of the obesity phenotypes and a more precise diagnosis are needed for improving the management of obese individuals.
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Affiliation(s)
- Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain
| | - Patricia Andrada
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Beatriz Ramírez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain
| | - Patricia Ibáñez
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Neus Vila
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sonia Romero
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - María A Margall
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - María J Gil
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
| | - Rafael Moncada
- Department of Anesthesiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Víctor Valentí
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Camilo Silva
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier Salvador
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
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Kowalczyk J, Mazurek M, Zielinska T, Lenarczyk R, Sedkowska A, Swiatkowski A, Sredniawa B, Mencel G, Francuz P, Kalarus Z. Prognostic significance of HbA1c in patients with AMI treated invasively and newly detected glucose abnormalities. Eur J Prev Cardiol 2014; 22:798-806. [DOI: 10.1177/2047487314527850] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 02/20/2014] [Indexed: 11/16/2022]
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Beckman JA, Paneni F, Cosentino F, Creager MA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part II. Eur Heart J 2013; 34:2444-52. [DOI: 10.1093/eurheartj/eht142] [Citation(s) in RCA: 225] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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