1
|
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.
Collapse
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
| |
Collapse
|
2
|
Kim NH, Kwon TY, Yu S, Kim NH, Choi KM, Baik SH, Park Y, Kim SG. Increased Vascular Disease Mortality Risk in Prediabetic Korean Adults Is Mainly Attributable to Ischemic Stroke. Stroke 2017; 48:840-845. [DOI: 10.1161/strokeaha.116.015947] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/06/2017] [Accepted: 01/20/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Prediabetes is a known risk factor for vascular diseases; however, its differential contribution to mortality risk from various vascular disease subtypes is not known.
Methods—
The subjects of the National Health Insurance Service in Korea (2002–2013) nationwide cohort were stratified into normal glucose tolerance (fasting glucose <100 mg/dL), impaired fasting glucose (IFG) stage 1 (100–109 mg/dL), IFG stage 2 (110–125 mg/dL), and diabetes mellitus groups based on the fasting glucose level. A Cox regression analysis with counting process formulation was used to assess the mortality risk for vascular disease and its subtypes—ischemic heart disease, ischemic stroke, and hemorrhagic stroke.
Results—
When adjusted for age, sex, and body mass index, IFG stage 2, but not stage 1, was associated with significantly higher all-cause mortality (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.18–1.34) and vascular disease mortality (HR, 1.27; 95% CI, 1.08–1.49) compared with normal glucose tolerance. Among the vascular disease subtypes, mortality from ischemic stroke was significantly higher (HR, 1.60; 95% CI, 1.18–2.18) in subjects with IFG stage 2 but not from ischemic heart disease and hemorrhagic stroke. The ischemic stroke mortality associated with IFG stage 2 remained significantly high when adjusted other modifiable vascular disease risk factors (HR, 1.51; 95% CI: 1.10–2.09) and medical treatments (HR, 1.75; 95% CI, 1.19–2.57).
Conclusions—
Higher IFG degree (fasting glucose, 110–125 mg/dL) was associated with increased all-cause and vascular disease mortality. The increased vascular disease mortality in IFG stage 2 was attributable to ischemic stroke, but not ischemic heart disease or hemorrhagic stroke in Korean adults.
Collapse
Affiliation(s)
- Nam Hoon Kim
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.)
| | - Tae Yeon Kwon
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.)
| | - Sungwook Yu
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.)
| | - Nan Hee Kim
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.)
| | - Kyung Mook Choi
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.)
| | - Sei Hyun Baik
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.)
| | - Yousung Park
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.)
| | - Sin Gon Kim
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.)
| |
Collapse
|
3
|
Priya MM, Amutha A, Pramodkumar TA, Ranjani H, Jebarani S, Gokulakrishnan K, Pradeepa R, Unnikrishnan R, Anjana RM, Mohan V. β-Cell Function and Insulin Sensitivity in Normal Glucose-Tolerant Subjects Stratified by 1-Hour Plasma Glucose Values. Diabetes Technol Ther 2016; 18:29-33. [PMID: 26492404 DOI: 10.1089/dia.2015.0065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM This study was designed to assess β-cell function and insulin sensitivity indices among normal glucose tolerance (NGT) subjects stratified by 1-h plasma glucose (1hPG) values during an oral glucose tolerance test (OGTT). MATERIALS AND METHODS One hundred sixty-six NGT subjects underwent a five-point OGTT, and glucose and insulin levels were estimated. We calculated the following indices: (a) β-cell function (homeostasis assessment model-β-cell function [HOMA-β] and Insulinogenic Index [IGI]) and (b) insulin sensitivity (homeostasis assessment model-insulin resistance [HOMA-IR], Matsuda Index, and Insulin Sensitivity Index [ISI]). RESULTS NGT subgroups with elevated 1hPG values (i.e., 1hPG ≥143 to <155 mg/dL and 1hPG ≥155 mg/dL) did not differ from those with 1hPG <143 mg/dL by HOMA-β (P = 0.236) but had significantly lower IGIs (367 ± 239 vs. 257 ± 243 vs. 246 ± 239; P = 0.019). With respect to ISIs, HOMA-IR was not significantly different among the groups (P = 0.103). However, the Matsuda Index (11.2 ± 5.0 vs. 7.4 ± 4.8 vs. 5.5 ± 4.9; P < 0.001) and ISI (0.015 ± 0.010 vs. 0.012 ± 0.006 vs. 0.011 ± 0.011; P = 0.028) were significantly lower in subjects with elevated 1hPG values. CONCLUSIONS NGT subjects with elevated 1hPG levels have alterations in β-cell function and insulin sensitivity compared with those with normal 1hPG levels.
Collapse
Affiliation(s)
- Miranda M Priya
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Anandakumar Amutha
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - T A Pramodkumar
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Harish Ranjani
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Saravanan Jebarani
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Kuppan Gokulakrishnan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Rajendra Pradeepa
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Ranjit Unnikrishnan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Ranjit Mohan Anjana
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases-Prevention and Control ; and International Diabetes Federation Centre of Education, Chennai, India
| |
Collapse
|
4
|
Jung CH, Seo GH, Suh S, Bae JC, Kim MK, Hwang YC, Kim JH, Lee BW. The Population-Based Risk of Need for Coronary Revascularization According to the Presence of Type 2 Diabetes Mellitus and History of Coronary Heart Disease in the Korean Population. PLoS One 2015; 10:e0128627. [PMID: 26053222 PMCID: PMC4459959 DOI: 10.1371/journal.pone.0128627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/29/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Whether diabetic patients without a history of coronary heart disease (CHD) have the same risk of CHD events as non-diabetic patients with a history of CHD remains controversial. This study aimed to determine whether type 2 diabetes mellitus (T2DM) is a coronary heart disease (CHD) equivalent in the need for coronary revascularization procedures (RVs) in the Korean population. METHODOLOGY/PRINCIPAL FINDINGS We followed 2,168,698 subjects who had oral anti-diabetic drugs (OADs)-taking T2DM in 2008 and/or CHD in 2007-2008 (i.e., recent CHD). We used systematic datasets from the nationwide claims database of the Health Insurance Review and Assessment service of Korea, which is representative of the whole population of Korea, from January 2007 to December 2012. The primary study endpoint was the development of need for RVs (i.e., incident CHD) after January 2009 among three groups based on their status of T2DM and recent CHD, i.e., T2DM only, recent CHD only, and both T2DM and recent CHD. After adjustment for age and sex, patients with recent CHD only had 2.14 times the risk of incident CHD (95% CI, 2.11-2.18, P<0.001) compared with patients with T2DM only. Patients with both T2DM and recent CHD demonstrated approximately 2-fold increased risk of incident CHD compared with subjects with recent CHD only (95% CI, 1.75-1.82), while 4-fold increased risk compared with subjects with T2DM only (95% CI, 3.71-3.87). The risk of incident CHD also differed according to sex and age. CONCLUSIONS/SIGNIFICANCE This analysis of data from the nationwide claims database revealed that T2DM did not have a recent CHD equivalent risk in the Korean population. These results suggest that an appropriate strategy for the CHD risk stratification in diabetic patients should be adopted to manage this population.
Collapse
Affiliation(s)
- Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi Hyeon Seo
- Health Insurance Review and Assessment Service, Seoul, Korea
| | - Sunghwan Suh
- Department of Internal Medicine, Dong-A University Medical Center, Busan, Korea
| | - Ji Cheol Bae
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mee Kyoung Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - You-Cheol Hwang
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, Severance Hospital, University of Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Abstract
PURPOSE As Korean society has become industrialized and westernized, the prevalence of diabetes has increased rapidly. Environmental factors, especially socio-economic status (SES), may account for the increased prevalence of diabetes. We evaluated the associations between the prevalence of diabetes and SES as reflected by household income and education level. MATERIALS AND METHODS This study was based on data obtained from the fifth Korea National Health and Nutrition Examination Survey, conducted in 2010-2012. Diabetes referred to a fasting plasma glucose ≥126 mg/dL in the absence of known diabetes, previous diagnosis of diabetes made by a physician, and/or current use of oral hypoglycemic agents or insulin. RESULTS Household income and education level were inversely associated with the prevalence of diabetes among individuals aged 30 years or older. These associations were more prominent in females aged 30-64 years. According to household income, the odds ratio (OR) [95% confidence interval (CI)] for the lowest quartile group versus the highest quartile group was 4.96 (2.87-8.58). According to education level, the OR (95% CI) for the lowest quartile group versus the highest quartile group was 8.02 (4.47-14.4). CONCLUSION Public policies for the prevention and management of diabetes should be targeted toward people of lower SES, especially middle-aged females.
Collapse
Affiliation(s)
- Yu Jeong Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Ja Young Jeon
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.; Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.; Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.; Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Kwan Woo Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.; Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea.
| |
Collapse
|