Glucose variability: a new risk factor for cardiovascular disease

Belli, Martina; Bellia, Alfonso; Sergi, Domenico; Barone, Lucy; Lauro, Davide; Barillà, Francesco

doi:10.1007/s00592-023-02097-w

Cited by 13 publications

(6 citation statements)

References 70 publications

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“…CVDs are the leading cause of morbidity and mortality in patients with diabetes; therefore, the prevention of cardiovascular (CV) complications is essential in the treatment of T2DM [32]. In recent years, there has been an expansion of the armamentarium for T2DM treatment with drugs that are not limited exclusively to glycemic control but also have positive effects on reducing CV risk.…”

Section: Glp-1ras and Reduction In Cardiovascular Riskmentioning

confidence: 99%

Beyond the Cardiovascular Effects of Glucagon-like Peptide-1 Receptor Agonists: Body Slimming and Plaque Stabilization. Are New Statins Born?

Lecis,

Prandi,

Barone

et al. 2023

Biomolecules

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Atherosclerosis is a chronic inflammatory disease characterized by lipid and inflammatory cell deposits in the inner layer of large- and medium-sized elastic and muscular arteries. Diabetes mellitus (DM) significantly increases the risk of cardiovascular diseases and the overall and cardiovascular mortality, and it is a pro-atherogenic factor that induces atherosclerosis development and/or accelerates its progression through a multifactorial process. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a new class of drugs, belonging to the armamentarium to fight type 2 DM, that have shown robust reductions in atherosclerotic events and all-cause mortality in all studies. Preclinical studies have shown that GLP-1RAs play a role in the immunomodulation of atherosclerosis, affecting multiple pathways involved in plaque development and progression. In this review, we wanted to explore the translational power of such preclinical studies by analyzing the most recent clinical trials investigating the atheroprotective effect of GLP-1RAs.

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Section: Glp-1ras and Reduction In Cardiovascular Riskmentioning

confidence: 99%

Beyond the Cardiovascular Effects of Glucagon-like Peptide-1 Receptor Agonists: Body Slimming and Plaque Stabilization. Are New Statins Born?

Lecis,

Prandi,

Barone

et al. 2023

Biomolecules

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“…Emerging research indicates that GV is an independent risk factor for diabetes mellitus (DM) complications, particularly in predicting cardiovascular risks [ 5 ]. Further investigations have established a correlation between acute GV and the severity and prognosis of various diseases, extending beyond DM [ 6 ] to encompass critically ill patients [ 7 ] and cardiovascular conditions [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of acute glycemic variability on short-term outcomes in patients with ST-segment elevation myocardial infarction: a multicenter population-based study

Wang,

Yang

et al. 2024

Cardiovasc Diabetol

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Background Given the increasing attention to glycemic variability (GV) and its potential implications for cardiovascular outcomes. This study aimed to explore the impact of acute GV on short-term outcomes in Chinese patients with ST-segment elevation myocardial infarction (STEMI). Methods This study enrolled 7510 consecutive patients diagnosed with acute STEMI from 274 centers in China. GV was assessed using the coefficient of variation of blood glucose levels. Patients were categorized into three groups according to GV tertiles (GV1, GV2, and GV3). The primary outcome was 30-day all-cause death, and the secondary outcome was major adverse cardiovascular events (MACEs). Cox regression analyses were conducted to determine the independent correlation between GV and the outcomes. Results A total of 7136 patients with STEMI were included. During 30-days follow-up, there was a significant increase in the incidence of all-cause death and MACEs with higher GV tertiles. The 30-days mortality rates were 7.4% for GV1, 8.7% for GV2 and 9.4% for GV3 (p = 0.004), while the MACEs incidence rates was 11.3%, 13.8% and 15.8% for the GV1, GV2 and GV3 groups respectively (p < 0.001). High GV levels during hospitalization were significantly associated with an increased risk of 30-day all-cause mortality and MACEs. When analyzed as a continuous variable, GV was independently associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.679, 95% confidence Interval [CI] 1.005–2.804) and MACEs (HR 2.064, 95% CI 1.386–3.074). Additionally, when analyzed as categorical variables, the GV3 group was found to predict an increased risk of MACEs, irrespective of the presence of diabetes mellitus (DM). Conclusion Our study findings indicate that a high GV during hospitalization was significantly associated with an increased risk of 30-day all-cause mortality and MACE in Chinese patients with STEMI. Moreover, acute GV emerged as an independent predictor of increased MACEs risk, regardless of DM status.

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“…Glycemic variability, oscillations in blood glucose levels, refers to the measurement of fluctuations in glucose or other related parameters of glucose homeostasis over a specific time period [9]. An elevated glycemic variability can contribute to the activation of oxidative stress, impairment of endothelial function, and glycosylation of proteins [10][11][12]. The findings of previous studies have demonstrated a positive correlation between glycemic variability and mortality in critically ill patients, including those with subarachnoid hemorrhage and sepsis [13,14].…”

Section: Introductionmentioning

confidence: 99%

Blood glucose fluctuation and in-hospital mortality among patients with acute myocardial infarction: eICU collaborative research database

Chen,

Huang,

Liang

2024

PLoS ONE

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Background To assess the relationship between glycemic variability, glucose fluctuation trajectory and the risk of in-hospital mortality in patients with acute myocardial infarction (AMI). Methods This retrospective cohort study included AMI patients from eICU Collaborative Research Database. In-hospital mortality of AMI patients was primary endpoint. Blood glucose levels at admission, glycemic variability, and glucose fluctuation trajectory were three main study variables. Blood glucose levels at admission were stratified into: normal, intermediate, and high. Glycemic variability was evaluated using the coefficient of variation (CV), divided into four groups based on quartiles: quartile 1: CV≤10; quartile 2: 10<CV≤20; quartile 3: 20<CV≤30; quartile 4: CV>30. Univariate and multivariate Cox regression models to assess the relationship between blood glucose levels at admission, glycemic variability, glucose fluctuation trajectory, and in-hospital mortality in patients with AMI. Results 2590 participants were eventually included in this study. There was a positive relationship between high blood glucose level at admission and in-hospital mortality [hazard ratio (HR) = 1.42, 95%confidence interval (CI): 1.06–1.89]. The fourth quartile (CV>30) of CV was associated with increased in-hospital mortality (HR = 2.06, 95% CI: 1.25–3.40). The findings indicated that only AMI individuals in the fourth quartile of glycemic variability, exhibited an elevated in-hospital mortality among those with normal blood glucose levels at admission (HR = 2.33, 95% CI: 1.11–4.87). Additionally, elevated blood glucose level was a risk factor for in-hospital mortality in AMI patients. Conclusion Glycemic variability was correlated with in-hospital mortality, particularly among AMI patients who had normal blood glucose levels at admission. Our study findings also suggest early intervention should be implemented to normalize high blood glucose levels at admission of AMI.

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Glucose variability: a new risk factor for cardiovascular disease

Cited by 13 publications

References 70 publications

Beyond the Cardiovascular Effects of Glucagon-like Peptide-1 Receptor Agonists: Body Slimming and Plaque Stabilization. Are New Statins Born?

Beyond the Cardiovascular Effects of Glucagon-like Peptide-1 Receptor Agonists: Body Slimming and Plaque Stabilization. Are New Statins Born?

Impact of acute glycemic variability on short-term outcomes in patients with ST-segment elevation myocardial infarction: a multicenter population-based study

Blood glucose fluctuation and in-hospital mortality among patients with acute myocardial infarction: eICU collaborative research database

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