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Edfors R, Jernberg T, Lewinter C, Blöndal M, Eha J, Lõiveke P, Marandi T, Ainla T, Saar A, Veldre G, Ferenci T, Andréka P, Jánosi A, Jortveit J, Halvorsen S. Differences in characteristics, treatments and outcomes in patients with non-ST-elevation myocardial infarction: novel insights from four national European continuous real-world registries. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:429-436. [PMID: 33605415 DOI: 10.1093/ehjqcco/qcab013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/29/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
AIMS To study baseline characteristics, in-hospital managements and mortality of non-ST-elevation myocardial infarction (NSTEMI) patients in different European countries. METHODS AND RESULTS NSTEMI patients enrolled in the national myocardial infarction (MI) registries [EMIR; n = 5817 (Estonia), HUMIR; n = 30 787 (Hungary), NORMI; n = 33 054 (Norway), and SWEDEHEART; n = 49 533 (Sweden)] from 2014 to 2017 were included and presented as aggregated data. The median age at admission ranged from 70 to 75 years. Current smoking status was numerically higher in Norway (24%), Estonia (22%), and Hungary (19%), as compared to Sweden (17%). Patients in Hungary had a high rate of diabetes mellitus (37%) and hypertension (84%). The proportion of performed coronary angiographies (58% vs. 75%) and percutaneous coronary interventions (38% vs. 56%), differed most between Norway and Hungary. Prescription of dual antiplatelet therapy at hospital discharge ranged from 60% (Estonia) to 81% (Hungary). In-hospital death ranged from 3.5% (Sweden) to 9% (Estonia). The crude mortality rate at 1 month was 12% in Norway and 5% in Sweden (5%), whereas the 1-year mortality rates were similar (20-23%) in Hungary, Estonia, and Norway and 15% in Sweden. CONCLUSION Cross-comparisons of four national European MI registries provide important data on differences in risk factors and treatment regiments that may explain some of the observed differences in death rates. A unified European continuous MI registry could be an option to better understand how implementation of guideline-recommended therapy can be used to reduce the burden of cardiovascular disease.
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Affiliation(s)
- Robert Edfors
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Morbygardsvagen 5, 1882 57 Stockholm, Sweden
- Bayer AB, Berzelius vag 35, 171 65 Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Morbygardsvagen 5, 1882 57 Stockholm, Sweden
| | - Christian Lewinter
- Heart and Vascular Theme, Section of Cardiology, Karolinska University Hospital, Eugeniavagen 23, 17165 Stockholm, Sweden
| | - Mai Blöndal
- Heart Clinic, Tartu University Hospital, 8 L. Puusepa Street, 50406 Tartu, Estonia
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 50406 Tartu, Estonia
| | - Jaan Eha
- Heart Clinic, Tartu University Hospital, 8 L. Puusepa Street, 50406 Tartu, Estonia
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 50406 Tartu, Estonia
| | - Piret Lõiveke
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 50406 Tartu, Estonia
- Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Street, 13419 Tallinn, Estonia
| | - Toomas Marandi
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 50406 Tartu, Estonia
- Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Street, 13419 Tallinn, Estonia
- Quality Department, North Estonia Medical Centre, 19 J. Sütiste Street, 13419 Tallinn, Estonia
| | - Tiia Ainla
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 50406 Tartu, Estonia
- Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Street, 13419 Tallinn, Estonia
| | - Aet Saar
- Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Street, 13419 Tallinn, Estonia
| | - Gudrun Veldre
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 50406 Tartu, Estonia
- Estonian Myocardial Infarction Registry, Tartu University Hospital, 8 L. Puusepa Street, 50406 Tartu, Estonia
| | - Tamas Ferenci
- John von Neumann Faculty of Informatics, Institute of Biomatics, Obuda University, Bécsi út 96/b, 1034 Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, Keleti Károly Street 5-7, 1024 Budapest, Hungary
| | - Péter Andréka
- Gottsegen György National Institute of Cardiology, Hungarian Myocardial Infarction Registry, Haller str 29, 096 Budapest Hungary, Hungary
| | - András Jánosi
- Gottsegen György National Institute of Cardiology, Hungarian Myocardial Infarction Registry, Haller str 29, 096 Budapest Hungary, Hungary
| | - Jarle Jortveit
- Department of Cardiology, Sorlandet Hospital, Box 783, Stoa, 4809 Arendal, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo and University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
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Gyldenkerne C, Knudsen JS, Olesen KKW, Sørensen HT, Bøtker HE, Thomsen RW, Maeng M. Nationwide Trends in Cardiac Risk and Mortality in Patients With Incident Type 2 Diabetes: A Danish Cohort Study. Diabetes Care 2021; 44:dc210383. [PMID: 34380704 DOI: 10.2337/dc21-0383] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/23/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Trends in cardiac risk and death have not been examined in patients with incident type 2 diabetes and no prior cardiovascular disease. Therefore, we aimed to examine trends in cardiac risk and death in relation to the use of prophylactic cardiovascular medications in patients with incident type 2 diabetes without prior cardiovascular disease. RESEARCH DESIGN AND METHODS In this population-based cohort study, we included patients with incident type 2 diabetes between 1996 and 2011 through national health registries. Each patient was matched by age and sex with up to five individuals without diabetes from the general population. All individuals were followed for 7 years. RESULTS We identified 209,311 patients with incident diabetes. From 1996-1999 to 2008-2011, the 7-year risk of myocardial infarction decreased from 6.9 to 2.8% (adjusted hazard ratio [aHR] 0.39 [95% CI 0.37-0.42]), cardiac death from 7.1 to 1.6% (aHR 0.23 [95% CI 0.21-0.24]), and all-cause death from 28.9 to 16.8% (aHR 0.68 [95% CI 0.66-0.69]). Compared with the general population, 7-year risk differences decreased from 3.3 to 0.8% for myocardial infarction, from 2.7 to 0.5% for cardiac death, and from 10.6 to 6.0% for all-cause death. Use of cardiovascular medications within ±1 year of diabetes diagnosis, especially statins (5% of users in 1996-1999 vs. 60% in 2008-2011), increased during the study period. CONCLUSIONS From 1996 to 2011, Danish patients with incident type 2 diabetes and no prior cardiovascular disease experienced major reductions in cardiac risk and mortality. The risk reductions coincided with increased use of prophylactic cardiovascular medications.
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Affiliation(s)
- Christine Gyldenkerne
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob S Knudsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin K W Olesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans E Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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3
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Predicting Long-Term Mortality in Patients with Angina across the Spectrum of Dysglycemia: A Machine Learning Approach. Diagnostics (Basel) 2021; 11:diagnostics11061060. [PMID: 34207578 PMCID: PMC8226455 DOI: 10.3390/diagnostics11061060] [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: 04/19/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 11/21/2022] Open
Abstract
We aimed to develop and validate a model for predicting mortality in patients with angina across the spectrum of dysglycemia. A total of 1479 patients admitted for coronary angiography due to angina were enrolled. All-cause mortality served as the primary endpoint. The models were validated with five-fold cross validation to predict long-term mortality. The features selected by least absolute shrinkage and selection operator (LASSO) were age, heart rate, plasma glucose levels at 30 min and 120 min during an oral glucose tolerance test (OGTT), the use of angiotensin II receptor blockers, the use of diuretics, and smoking history. This best performing model was built using a random survival forest with selected features. It had a good discriminative ability (Harrell’s C-index: 0.829) and acceptable calibration (Brier score: 0.08) for predicting long-term mortality. Among patients with obstructive coronary artery disease confirmed by angiography, our model outperformed the Global Registry of Acute Coronary Events discharge score for mortality prediction (Harrell’s C-index: 0.829 vs. 0.739, p < 0.001). In conclusion, we developed a machine learning model to predict long-term mortality among patients with angina. With the integration of OGTT, the model could help to identify a high risk of mortality across the spectrum of dysglycemia.
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4
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Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, Federici M, Filippatos G, Grobbee DE, Hansen TB, Huikuri HV, Johansson I, Jüni P, Lettino M, Marx N, Mellbin LG, Östgren CJ, Rocca B, Roffi M, Sattar N, Seferović PM, Sousa-Uva M, Valensi P, Wheeler DC. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2021; 41:255-323. [PMID: 31497854 DOI: 10.1093/eurheartj/ehz486] [Citation(s) in RCA: 2319] [Impact Index Per Article: 773.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Bonora E, Dauriz M, Rinaldi E, Mantovani A, Boscari F, Mazzuccato M, Vedovato M, Gallo A, Toffanin E, Lapolla A, Fadini GP, Avogaro A. Assessment of simple strategies for identifying undiagnosed diabetes and prediabetes in the general population. J Endocrinol Invest 2021; 44:75-81. [PMID: 32342446 DOI: 10.1007/s40618-020-01270-0] [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: 04/09/2020] [Accepted: 04/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The rising tide of diabetes mellitus (DM) and prediabetes (PDM) is urgently calling for strategies easily applicable to anticipate diagnosis. We assessed the effectiveness of random capillary blood glucose (RCBG), administration of a validated DM risk questionnaire, or the combination of both. MATERIALS AND METHODS RCBG measurement and/or questionnaire administration were offered to all individuals presenting at gazebos organized during the World Diabetes Day or similar public initiatives on diabetes awareness. Subjects with suspicious DM or PDM were invited to the Diabetes Center (DC) for laboratory confirmation (fasting plasma glucose and HbA1c). RESULTS Among 8563 individuals without known diabetes undergoing RCBG measurement, 341 (4%) had suspicious values. Diagnosis of DM was confirmed in 36 (41.9%) of the 86 subjects who came to the DC and PDM was found in 40 (46.5%). Among 3351 subjects to whom the questionnaire was administered, 480 (14.3%) had suspicious scores. Diagnosis of DM was confirmed in 40 (10.1%) of the 397 who came to the DC and PDM was found in 214 (53.9%). These 3351 subjects also had RCBG measurement and 30 out of them had both tests positive. Among them, 27 subjects came to DC and DM was diagnosed in 17 (63.0%) and PDM was found in 9 (33.3%). CONCLUSIONS These data suggest that RCBG definitely outperforms the questionnaire to identify unknown DM and PDM. RCBG measurement, with questionnaire as an adjunctive tool, appears to be a simple, fast, and feasible opportunistic strategy in detecting undiagnosed DM and PDM.
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Affiliation(s)
- E Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - M Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
- Department of Internal Medicine, Section of Endocrinology and Diabetes, Bolzano General Hospital, Bolzano, Italy
| | - E Rinaldi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - A Mantovani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - F Boscari
- Department of Medicine, University of Padua, Padua, Italy
| | - M Mazzuccato
- Department of Medicine, University of Padua, Padua, Italy
| | - M Vedovato
- Department of Medicine, University of Padua, Padua, Italy
| | - A Gallo
- Department of Medicine, University of Padua, Padua, Italy
| | - E Toffanin
- Department of Medicine, University of Padua, Padua, Italy
| | - A Lapolla
- Department of Medicine, University of Padua, Padua, Italy
| | - G P Fadini
- Department of Medicine, University of Padua, Padua, Italy
| | - A Avogaro
- Department of Medicine, University of Padua, Padua, Italy
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Matz K, Tuomilehto J, Teuschl Y, Dachenhausen A, Brainin M. Comparison of oral glucose tolerance test and HbA1c in detection of disorders of glucose metabolism in patients with acute stroke. Cardiovasc Diabetol 2020; 19:204. [PMID: 33278898 PMCID: PMC7719250 DOI: 10.1186/s12933-020-01182-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background Diabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis. Yet a large proportion of stroke patients who are eventually diabetic are undiagnosed. Therefore, it is important to have sensitive assessment of unrecognized hyperglycaemia in stroke patients. Design Secondary outcome analysis of a randomized controlled trial focussing on parameters of glucose metabolism and detection of diabetes and prediabetes in patients with acute ischemic stroke (AIS). Methods A total of 130 consecutively admitted patients with AIS without previously known type 2 diabetes mellitus (T2DM) were screened for diabetes or prediabetes as part of secondary outcome analysis of a randomized controlled trial that tested lifestyle intervention to prevent post-stroke cognitive decline. Patients had the oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) measurements in the second week after stroke onset and after 1 year. The detection rates of diabetes and prediabetes based on the OGTT or HbA1c values were compared. Results By any of the applied tests at the second week after stroke onset 62 of 130 patients (48%) had prediabetes or T2DM. Seventy-five patients had results from both tests available, the OGTT and HbA1c; according to the OGTT 40 (53.3%) patients had normal glucose metabolism, 33 (44%) had prediabetes, two (2.7%) T2DM. In 50 (66.7%) patients the HbA1c results were normal, 24 (32%) in the prediabetic and one (1.3%) in the diabetic range. The detection rate for disorders of glucose metabolism was 10% higher (absolute difference; relative difference 29%) with the OGTT compared with HbA1c. After 1 year the detection rate for prediabetes or T2DM was 7% higher with the OGTT (26% relative difference). The study intervention led to a more favourable evolution of glycemic status after 1 year. Conclusion The OGTT is a more sensitive screening tool than HbA1c for the detection of previously unrecognized glycemic disorders in patients with acute stroke with an at least a 25% relative difference in detection rate. Therefore, an OGTT should be performed in all patients with stroke with no history of diabetes. Trial registrationhttp://clinicaltrials.gov. Unique identifier: NCT01109836.
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Affiliation(s)
- Karl Matz
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria. .,Department of Neurology, Landesklinikum Baden-Mödling, Mödling, Austria.
| | - Jaakko Tuomilehto
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,National School of Public Health, Madrid, Spain.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yvonne Teuschl
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Alexandra Dachenhausen
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Michael Brainin
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
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Ferrannini G, Norhammar A, Gyberg V, Mellbin L, Rydén L. Is Coronary Artery Disease Inevitable in Type 2 Diabetes? From a Glucocentric to a Holistic View on Patient Management. Diabetes Care 2020; 43:2001-2009. [PMID: 32661109 DOI: 10.2337/dci20-0002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 02/03/2023]
Affiliation(s)
| | - Anna Norhammar
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Viveca Gyberg
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Linda Mellbin
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
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8
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Guía ESC 2019 sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes (EASD). Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Geva M, Shlomai G, Berkovich A, Maor E, Leibowitz A, Tenenbaum A, Grossman E. The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension. Cardiovasc Diabetol 2019; 18:53. [PMID: 31029146 PMCID: PMC6486972 DOI: 10.1186/s12933-019-0859-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background Prediabetes is a well-established risk factor for progression to overt diabetes mellitus (DM), which is in turn associated with development of hypertension (HTN) and vice versa. However, the role of prediabetes and HbA1c in particular as an independent risk factor for the development of hypertension is unclear. Aim In this current study, we aimed to evaluate the association between both fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels in the prediabetes range and development of HTN among a large cohort of normotensive subjects. Design and methods We investigated 5016 normotensive participants without DM and other cardiovascular risk factors who were annually screened in a tertiary medical center. Subjects were divided into normoglycemic and prediabetic groups. Normoglycemia was defined as HbA1c < 5.7% and FPG < 100 mg/dl. Prediabetes was defined according to the ADA criteria, i.e., 6.5% > HbA1c ≥ 5.7% or impaired fasting glucose (IFG):126 mg/dl > FPG ≥ 100 mg/dl. Subgroup analysis was made by dividing participants into four groups according to FPG and HbA1C levels, i.e., normoglycemia, impaired HbA1c only, IFG only, and both parameters impaired. Results During a follow-up of 3.7 ± 2.9 years, 318 (6.3%) subjects developed HTN. A cumulative hazard function for the development of hypertension showed a 2.89-fold ([95% CI 2.19–3.83], p < .0001) increased risk for HTN in the prediabetic population. In a multivariable Cox proportional hazard regression model adjusted to common confounding risk factors for HTN, prediabetes was found to be independently associated with a 1.95-fold ([95%, CI 1.43–2.52] p < .0001) increased risk for hypertension. Impaired HbA1C only was not found to be independently associated with HTN, while IFG only showed a 2.13-fold (95%, [CI 1.46–3.11] p < .0001) increased risk for HTN compared to normoglycemic, and a 2.55-fold ([95% CI 1.85–3.51] p < .0001) increased risk for HTN when both parameters impaired. Conclusion Our study demonstrates that FPG in the prediabetes range, albeit not glycated hemoglobin, is independently and significantly associated with future development of HTN. Therefore, our findings further highlight the pivotal predictive role of IFG for HTN development as opposed to the limited independent role of abnormal HbA1c levels. Electronic supplementary material The online version of this article (10.1186/s12933-019-0859-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mika Geva
- Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Gadi Shlomai
- Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Anat Berkovich
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Elad Maor
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Avshalom Leibowitz
- Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Alexander Tenenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ehud Grossman
- Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
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Shahim B, Kjellström B, Gyberg V, Jennings C, Smetana S, Rydén L. The Accuracy of Point-of-Care Equipment for Glucose Measurement in Screening for Dysglycemia in Patients with Coronary Artery Disease. Diabetes Technol Ther 2018; 20:596-602. [PMID: 30074818 DOI: 10.1089/dia.2018.0157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Point-of-care equipment for measuring glucose saves time and costs for both patients and professionals and minimizes preanalytic errors when screening for or managing dysglycemia, that is, impaired glucose tolerance and type 2 diabetes. The accuracy of such devices has, however, been questioned compared with analyses at an accredited hospital laboratory. OBJECTIVE To investigate the agreement between glucose measurements made by the point-of-care HemoCue® Glucose 201 RT System (HemoCue, Ängelholm, Sweden) and local hospital laboratories. MATERIAL Patients with established coronary artery disease (CAD) recruited in Sweden and the United Kingdom within the auspices of the European Action on Secondary and primary Prevention by Intervention to Reduce Events (EUROASPIRE) V survey (n = 87; 18-80 years) with or without previously known dysglycemia were investigated. Plasma glucose values collected in the fasting state (n = 85) and 60 (n = 57) and 120 (n = 72) min after a glucose load were analyzed both using HemoCue monitors and local hospital laboratories. The two measurement techniques were compared using a bias plot according to Bland-Altman, the surveillance error grid, and Spearman correlation test. RESULTS The bias plot method showed small differences between the HemoCue and local hospital laboratory methods, the HemoCue and central hospital laboratory, and the local hospital laboratories and the central hospital laboratory. In the surveillance error grid, 98.6% of the values were in the deep green zone, indicating no risk and the remaining values (1.4%) were within the light green zone, indicating "slight lower risk." CONCLUSION The HemoCue point-of-care system is accurate for dysglycemia screening in patients with CAD.
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Affiliation(s)
- Bahira Shahim
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Barbro Kjellström
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Viveca Gyberg
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
- 2 Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet , Huddinge, Sweden
| | - Catriona Jennings
- 3 Faculty of Medicine, NHLI Imperial College London , Hammersmith Campus, London, United Kingdom
| | - Stina Smetana
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
| | - Lars Rydén
- 1 Cardiology Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
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