Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort

Stacey, Richard; Zgibor, Janice C.; Leaverton, Paul E.; Schocken, Douglas D.; Peregoy, Jennifer; Lyles, Mary F.; Bertoni, Alain G.; Burke, Gregory L.

doi:10.1111/jgs.15604

Cited by 14 publications

(6 citation statements)

References 56 publications

(105 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study showed that those with diabetes mellitus had the significantly longer decision times. Diabetes Mellitus is not only a major risk factor of coronary artery disease, it also results in silent MI [ 35 ] and more atypical symptoms, all of which could contribute to delays in recognizing symptoms, and hence delays in presentation. A large percentage (53.8%) of the patients in our study attributed their symptoms to PUD or acid reflux.…”

Section: Discussionmentioning

confidence: 99%

Pre hospital delay and its associated factors in acute myocardial infarction in a developing country

et al. 2021

View full text Add to dashboard Cite

Background Early revascularization and treatment is key to improving clinical outcomes and reducing mortality in acute myocardial infarction (AMI). In low- and middle-income countries such as Bangladesh, timely management of AMI is challenging, with pre-hospital delays playing a significant role. This study was designed to investigate pre-hospital delay and its associated factors among patients presenting with AMI in the capital city of Dhaka. Methods This retrospective cohort study was conducted on 333 patients presenting with AMI over a 3-month period at two of the largest primary reperfusion-capable tertiary cardiac care centres in Dhaka. Of the total patients, 239(71.8%) were admitted in the National Institute of Cardiovascular Diseases, Dhaka and 94(28.2%) at Ibrahim Cardiac Hospital & Research Institute, Dhaka Data were collected from patients by semi-structured interview and hospital medical records. Pre-hospital delay (median and inter-quartile range) was calculated. Statistical significance was determined by Chi-square test. Multivariate logistic regression analysis was done to determine the independent predictors of pre-hospital delay. Results The mean age of the respondents was 53.8±11.2 years. Two-thirds (67.6%) of the respondents were males. Median total pre-hospital delay was 11.5 (IQR-18.3) hours with median decision time from symptom onset to seeking medical care being 3.0 (IQR: 11.0) hours. Nearly half (48.9%) of patients presented to the hospital more than 12 hours after symptom onset. On multivariate logistic regression analysis, AMI patients with absence of typical chest pain [OR 5.21; (95% CI: 2.5–9.9)], diabetes [OR: 1.7 (95% CI: 1.0–2.9)], residing/staying > 30 km away from nearest hospital at the time of onset [OR: 4.3(95% CI = 2.3–7.2)] and belonged to lower and middle class [OR: 1.9(95% CI = 1.0–3.5)] were significantly associated with pre-hospital delays. Conclusion Acute myocardial infarction (AMI) patients with atypical chest pain, diabetes, staying far away from nearest hospital and belonged to lower and middle socioeconomic strata were significantly associated with pre-hospital delays. The findings could have immense implications for improvements about timely reaching of AMI patients to the hospital within the context of their sociodemographic status and geographic barriers of the city.

show abstract

Section: Discussionmentioning

confidence: 99%

Pre hospital delay and its associated factors in acute myocardial infarction in a developing country

et al. 2021

View full text Add to dashboard Cite

show abstract

“…8 The Cardiovascular Health Study group reported that abnormal fasting glucose increases the risk of unrecognized MI in an older adult cohort. 9 In a study conducted in Iceland, all-cause mortality of unrecognized MI was higher than MI, and unrecognized MI was associated with an elevated risk of nonfatal MI and heart failure. 10 It was reported that individuals who experience unrecognized MI had reduced pain sensitivity compared with people who experienced recognized MI.…”

mentioning

confidence: 97%

“…In addition, in the UK Prospective Diabetes Study, approximately 1 in 6 patients with newly diagnosed type 2 DM had evidence of SMI 8 . The Cardiovascular Health Study group reported that abnormal fasting glucose increases the risk of unrecognized MI in an older adult cohort 9 . In a study conducted in Iceland, all-cause mortality of unrecognized MI was higher than MI, and unrecognized MI was associated with an elevated risk of nonfatal MI and heart failure 10 .…”

mentioning

confidence: 99%

Risk of Silent Myocardial Infarction in Prediabetic Patients: A Case-Control Study in a Veteran Population

Naik

Dongarwar

Leonelli

et al. 2021

Southern Medical Journal

View full text Add to dashboard Cite

Objectives: In the management of cardiovascular disease, it is important to identify patients at risk early on, to provide interventions to prevent the disease and its complications. The goal of our study was to investigate the association between glucose levels and silent myocardial infarction (SMI) among patients, who consisted of veterans within the Veterans Affairs clinical system.Methods: Among the group of patients with an initially normal electrocardiogram, a cohort of patients with a subsequent diagnosis of SMI was selected as the case cohort, whereas 4 patients for each study subject, without evidence of coronary artery disease and normal electrocardiogram within the previous 6 months, were identified and constituted the control cohort. We conducted an adjusted logistic regression model using the stepwise function to assess the association between glucose level and SMI.Results: Of the 540 patients included in the study, 108 (20.0%) with an SMI diagnosis made up the case cohort. We observed that as compared with those who had normal levels of glucose, those who were prediabetic were 3.99 times as likely (95% confidence interval 1.48-12.85) to have SMI, whereas the diabetic patients were 3.80 times as likely (95% confidence interval 1.39-12.38) to experience SMI.Conclusions: SMIs have been shown to be predictive of subsequent cardiovascular events, including another MI and death, and that indicates the importance of identifying a group at high risk for a SMI. As such, our findings could be extremely beneficial for targeted intervention toward prediabetics and to improve health outcomes in the entire population.

show abstract

“…In the light of differences in ECG diagnostic criteria and study population, there is wide variability in prevalence estimation for silent MI [15]; however, the prevalence of silent MI may reach up to 6.4% in general populations [16], and being more prevalent among diabetic patients. Moreover, diabetes and prediabetes status could be a predictive and associated factors for silent MI [16,17], but about prediabetes, the relation is less clear and necessitates further studies [18].…”

mentioning

confidence: 99%

Sex-specific Prevalence of coronary heart disease among Tehranian adult population across different glycemic status: Tehran Lipid and Glucose Study, 2008-2011

Moazzeni

Ghafelehbashi

Hasheminia

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Coronary heart disease (CHD) is one of the most common causes of deaths and alarmingly Iranian populations had a high rank of CHD worldwide. The object of the current study is to assess the prevalence of CHD, including clinical CHD and silent myocardial infarction (MI) across different glycemic categories.Methods: This study was conducted on 7,368 Tehranian participants (Men=3312), aged ≥ 30 years from 2008 to 2011. Clinical CHD was defined as hospital records which approved by an outcome committee. Using Minnesota Code ECG classifications, silent MI was defined by appearance of major abnormal Q/QS waves (MC 1.1 or MC 1.2), or minor abnormal Q/QS waves (MC 1.3) plus major abnormal ST-T (MC 4.1, MC 4.2, MC 5.1 or MC 5.2.)Results: Among the total population, the age-standardized prevalence of CHD was 12.82% [confidence interval (CI) 95%:12.11-13.53]. The age-standardized prevalences of total CHD, clinical CHD and silent MI were 13.42% (12.33-14.5), 9.69% (8.81-10.56) and 3.73% (3.04-4.43) for men and were 12.70% (11.73-13.66), 8.56% (7.79-9.33) and 4.14% (3.50-4.78) for women, respectively. Moreover, 17.67% (13.90-21.44) of the male and 18.94% (14.59-23.30) of the female diabetic population had CHD. Specifically, the prevalence of total CHD among known and newly diagnosed diabetic populations and those with combined impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were 19.53% (15.22-23.84), 16.12% (12.29-19.94) and 16.84% (11.85-21.83), respectively. Compared to other glycemic categories, the prevalence of silent MI was higher among those with combined IFG and IGT (6.80 (2.84-10.76)), although it didn’t reach a significant level.Conclusion: The high prevalence of CHD, especially among those suffering from both IFG and IGT and diabetic populations, necessitates urgent implementation behavioral interventions among Tehranian populations, evidence based on guidelines for clinical management of diabetic patients.

show abstract

Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort

Cited by 14 publications

References 56 publications

Pre hospital delay and its associated factors in acute myocardial infarction in a developing country

Pre hospital delay and its associated factors in acute myocardial infarction in a developing country

Risk of Silent Myocardial Infarction in Prediabetic Patients: A Case-Control Study in a Veteran Population

Sex-specific Prevalence of coronary heart disease among Tehranian adult population across different glycemic status: Tehran Lipid and Glucose Study, 2008-2011

Contact Info

Product

Resources

About