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Wei W, Liang Y, Guo D, Xu X, Xu Q, Li S, Li Y, Liu J, Liu Y, Tu M, Chen K, Chen H, Chen S. Hyperglycemia newly detected by glycated hemoglobin affects all-cause mortality in coronary artery disease patients: a retrospective cohort study. Diabetes Res Clin Pract 2022; 191:110053. [PMID: 36038089 DOI: 10.1016/j.diabres.2022.110053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Abstract
AIMS We aim to assess the relationship between hyperglycemia and long-term prognosis in CAD patients without known diabetes. METHODS In this retrospective observational study, we enrolled 11,384 CAD patients without known diabetes. Newly detected diabetes was defined as HbA1c ≥ 6.5 %, and prediabetes was defined as HbA1c ranging from 5.7 to 6.4 %.The association between hyperglycemia and long-term all-cause mortality was examined using Cox proportional hazards regression analysis. RESULTS According to HbA1c level, 8207 (72.1 %) patients had hyperglycemia, including 13.0 % with diabetes and 59.1 % with prediabetes. During a median follow-up of 4.9 years, 1157(10.2 %) patients died. Compared with normoglycemia, hyperglycemia was associated with increased risk for long-term mortality (adjusted hazard ratio for diabetes and prediabetes: 1.23 [95 % confidence interval (CI): 1.00 to 1.51] and 1.17 [95 % CI: 1.01 to 1.36], respectively). CONCLUSIONS Hyperglycemia detected by HbA1c was common in CAD patients without known diabetes and was associated with increased long-term mortality. It is necessary to routinely use HbA1c to assess glucose metabolic status in CAD patients and treat hyperglycemia as early as possible to reduce the risk of adverse outcomes.
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Affiliation(s)
- Wen Wei
- Global Health Research Center,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Yan Liang
- Department of Cardiology, Maoming People's Hospital, Maoming 525000, China
| | - Dachuan Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Xinghao Xu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Qingbo Xu
- Department of Cardiology, Maoming People's Hospital, Maoming 525000, China
| | - Shanggang Li
- Global Health Research Center,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yuqi Li
- Department of Cardiology, Zhong Shan City People's Hospital, Zhong Shan 528403, China
| | - Jin Liu
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yong Liu
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510100, China
| | - Mei Tu
- Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China.
| | - Hong Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China.
| | - Shiqun Chen
- Global Health Research Center,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
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Deleterious synergistic effects of acute heart failure and diabetes mellitus in patients with acute coronary syndrome: Data from the FAST-MI Registries. Arch Cardiovasc Dis 2022; 115:264-275. [DOI: 10.1016/j.acvd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 11/19/2022]
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Józwa R, Bryśkiewicz M, Safranow K, Majkowska L. HbA1c Screening for Diabetes in Patients with Acute Coronary Syndrome: A Worthwhile Test or a Pitfall? J Clin Med 2021; 10:jcm10194334. [PMID: 34640351 PMCID: PMC8509534 DOI: 10.3390/jcm10194334] [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: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Diagnostic concordance between HbA1c and other glucose-based tests is imperfect, and data on this problem in acute coronary syndrome (ACS) are still lacking. The aim of this study was to identify undiagnosed glucose abnormalities in ACS patients, and to compare the effectiveness and consistency of the diagnostic screening based on HbA1c to the oral glucose tolerance test (OGTT). Methods: The study group consisted of 121 ACS patients, mean age 62.3 ± 11.6 years, without known glucose abnormalities. HbA1c, admission and fasting plasma glucose in the first days of hospitalization were assessed and referred to the results of OGTT performed two weeks after discharge. Results: OGTT identified normoglycemia in 45%, pre-diabetes in 39.4%, and diabetes in 15.6%, while HbA1c revealed these categories in 39.7%, 51.2%, and 9.1%, respectively. With an HbA1c cut-off ≥6.5% (48 mmol/mol) diagnostic for diabetes, the sensitivity of the method was 41%, while specificity was 98%, compared to the OGTT. The optimal HbA1c cut-off value at the crossing of sensitivity and specificity curves was 5.9%. The HbA1c value recommended for the diagnosis of pre-diabetes and optimal cut-off point were the same (5.7%). Conclusions: Using HbA1c without OGTT in an early but stable phase of ACS may result in a significant underdiagnosis of diabetes.
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Affiliation(s)
- Robert Józwa
- Department of Cardiology and Invasive Cardiology, Provincial Hospital, ul. Arkońska 4, 71-455 Szczecin, Poland;
| | - Marta Bryśkiewicz
- Department of Diabetology and Internal Diseases, Pomeranian Medical University, ul. Siedlecka 2, Police, 72-010 Szczecin, Poland;
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich Av. 72, 70-111 Szczecin, Poland;
| | - Liliana Majkowska
- Department of Diabetology and Internal Diseases, Pomeranian Medical University, ul. Siedlecka 2, Police, 72-010 Szczecin, Poland;
- Correspondence:
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Bailey A, Korda R, Agostino J, Stanton T, Kelly G, Richman T, Greaves K. Absolute cardiovascular disease risk score and pharmacotherapy at the time of admission in patients presenting with acute coronary syndrome due to coronary artery disease in a single Australian tertiary centre: a cross-sectional study. BMJ Open 2021; 11:e038868. [PMID: 33558345 PMCID: PMC7871691 DOI: 10.1136/bmjopen-2020-038868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/21/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To describe (1) absolute cardiovascular disease risk (ACVDR) scores in patients presenting to hospital with acute coronary syndrome (ACS) and (2) proportions of these patients on guideline-recommended pharmacotherapy according to their ACVDR score. DESIGN Cross-sectional study. SETTING Single-site tertiary centre hospital, Queensland, Australia over a 12-month period. PARTICIPANTS Patients >18 years of age presenting to hospital with ACS due to coronary artery disease (CAD) confirmed by angiography. PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of patients without prior history of CVD with a high ACVDR score, and of patients with a prior history of CVD, who are on guideline-recommended pharmacotherapy. RESULTS 527 ACS patients were included of whom the mean age was 63 years and 75% were male. Overall, 66% (350) had no prior CVD and 34% (177) patients had prior CVD.In patients with no prior CVD, the proportions of patients with low, intermediate and high CVD risk scores were 41%, 24% and 36%. In the no prior CVD, high-risk patient group, 48% were on no preventative pharmacotherapy, 32% on single pharmacotherapy and 20% patients on complete guideline-recommended pharmacotherapy. In the prior CVD group, 7% patients were on no pharmacotherapy, 40% on incomplete pharmacotherapy and 53% were on complete guideline-recommended pharmacotherapy. CONCLUSION This study adds to the evidence on implementation gaps in guideline-recommended management of ACVDR, showing that a large proportion of patients presenting with ACS due to CAD were at high risk of developing CVD prior to the event and most were not on guideline-recommended treatment. A significant proportion of these events are likely to have been preventable, and therefore, increased assessment and appropriate treatment of ACVDR in primary care is needed to reduce the incidence of CVD events in the population.
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Affiliation(s)
- Amy Bailey
- Department of Cardiology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jason Agostino
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Tony Stanton
- Department of Cardiology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Gabriela Kelly
- Mater Health Services Brisbane, South Brisbane, Queensland, Australia
| | - Tuppence Richman
- Department of Cardiology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - K Greaves
- Department of Cardiology, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
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Ding Q, Spatz ES, Lipska KJ, Lin H, Spertus JA, Dreyer RP, Whittemore R, Funk M, Bueno H, Krumholz HM. Newly diagnosed diabetes and outcomes after acute myocardial infarction in young adults. Heart 2020; 107:657-666. [PMID: 33082173 PMCID: PMC8005796 DOI: 10.1136/heartjnl-2020-317101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 12/02/2022] Open
Abstract
Objective To examine prevalence and characteristics of newly diagnosed diabetes (NDD) in younger adults hospitalised with acute myocardial infarction (AMI) and investigate whether NDD is associated with health status and clinical outcomes over 12-month post-AMI. Methods In individuals (18–55 years) admitted with AMI, without established diabetes, we defined NDD as (1) baseline or 1-month HbA1c≥6.5%; (2) discharge diabetes diagnosis or (3) diabetes medication initiation within 1 month. We compared baseline characteristics of NDD, established diabetes and no diabetes, and their associations with baseline, 1-month and 12-month health status (angina-specific and non-disease specific), mortality and in-hospital complications. Results Among 3501 patients in Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study, 14.5% met NDD criteria. Among 508 patients with NDD, 35 (6.9%) received discharge diagnosis, 91 (17.9%) received discharge diabetes education and 14 (2.8%) initiated pharmacological treatment within 1 month. NDD was more common in non-White (OR 1.58, 95% CI 1.23 to 2.03), obese (OR 1.72, 95% CI 1.39 to 2.12), financially stressed patients (OR 1.27, 95% CI 1.02 to 1.58). Compared with established diabetes, NDD was independently associated with better disease-specific health status and quality of life (p≤0.04). No significant differences were found in unadjusted in-hospital mortality and complications between NDD and established or no diabetes. Conclusions NDD was common among adults≤55 years admitted with AMI and was more frequent in non-White, obese, financially stressed individuals. Under 20% of patients with NDD received discharge diagnosis or initiated discharge diabetes education or pharmacological treatment within 1 month post-AMI. NDD was not associated with increased risk of worse short-term health status compared with risk noted for established diabetes. Trial registration number NCT00597922.
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Affiliation(s)
- Qinglan Ding
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.,College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA.,Yale School of Nursing, West Haven, Connecticut, USA
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kasia J Lipska
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.,Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Haiqun Lin
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.,School of Nursing, Rutgers University, Newark, New Jersey, USA
| | - John A Spertus
- Cardiovascular Outcomes Research, St. Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.,Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Marjorie Funk
- Yale School of Nursing, West Haven, Connecticut, USA
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigacion i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA .,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
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Karakurt M, Acar B, Ozeke O, Ozbay MB, Ozen Y, Karanfil M, Unal S, Yayla C, Cay S, Maden O, Aras D, Topaloglu S, Aydogdu S, Golbasi Z. Advantages and Pitfalls of the Glycated Hemoglobin A1c Measurement in Acute Coronary Syndrome: Start Simple, Evolve to More Sophisticated. Angiology 2018; 70:182-184. [DOI: 10.1177/0003319718800570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Mustafa Karakurt
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Burak Acar
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Mustafa Bilal Ozbay
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Yasin Ozen
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Mustafa Karanfil
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Sefa Unal
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Cagri Yayla
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Orhan Maden
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Sinan Aydogdu
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Zehra Golbasi
- Department of Cardiology, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
- Department of Cardiology, Hitit University, Corum, Turkey
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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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