High cortisol levels in hyperglycaemic myocardial infarct patients signify stress hyperglycaemia and predict subsequent normalization of glucose tolerance

Wong, Kai; Wong, Vincent W.; Ho, J. T.; Torpy, David J.; McLean, Mark; Cheung, N. Wah

doi:10.1111/j.1365-2265.2009.03654.x

Cited by 22 publications

(16 citation statements)

References 25 publications

(44 reference statements)

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“…Increased HbA 1c represents long-term glucose regulation, whereas elevated admission glucose excursion is not only a symptom of glucose dysregulation, but also of stress and general poor health. Carmen Wong et al (30) found cortisol level is correlated with acute hyperglycemia in patients with AMI. In our Kaplan-Meier survival-curve analysis, only a trend toward lower event-free survival rate in AMI patients with HbA 1c ≥6.5% ( P = 0.055) was observed.…”

Section: Discussionmentioning

confidence: 99%

Impact of Admission Glycemic Variability, Glucose, and Glycosylated Hemoglobin on Major Adverse Cardiac Events After Acute Myocardial Infarction

et al. 2013

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OBJECTIVEDysglycemia is associated with poorer prognosis in patients with acute myocardial infarction (AMI). Whether admission glycemic variability (GV) has important value in prognosis of AMI patients is still unknown. The aim of the study is to investigate the prognostic value of admission GV, glucose, and glycosylated hemoglobin (HbA1c) in AMI patients.RESEARCH DESIGN AND METHODSWe measured blood glucose, HbA1c, and GV on admission in 222 consecutive patients with diagnosed AMI. GV, indicated as the mean amplitude of glycemic excursions (MAGE), was determined by a continuous glucose monitoring system. MAGE was categorized as ≥3.9 or <3.9 mmol/L, admission glucose as ≥8.61 or <8.61 mmol/L, and HbA1c as ≥6.5 or <6.5%. Participants were followed up prospectively for 12 months. The relationship of admission MAGE, glucose, and HbA1c to the major adverse cardiac event (MACE) of AMI patients was analyzed.RESULTSIn 222 enrolled patients with AMI, the rate of MACE by MAGE category (<3.9 or ≥3.9 mmol/L) was 8.4 and 24.1%, respectively (P = 0.001), by admission glucose category (<8.61 or ≥8.61 mmol/L) was 10.1 and 21.6%, respectively (P = 0.020), and by HbA1c category (<6.5 vs. ≥6.5%) was 10.7 versus 18.7%, respectively (P = 0.091). In multivariate analysis, high MAGE level was significantly associated with incidence of MACE (hazard ratio 2.419 [95% CI 1.273–9.100]; P = 0.017) even after adjusting for Global Registry of Acute Coronary Events risk score, but admission glucose and HbA1c was not.CONCLUSIONSElevated admission GV appears more important than admission glucose and prior long-term abnormal glycometabolic status in predicting 1-year MACE in patients with AMI.

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Section: Discussionmentioning

confidence: 99%

Impact of Admission Glycemic Variability, Glucose, and Glycosylated Hemoglobin on Major Adverse Cardiac Events After Acute Myocardial Infarction

et al. 2013

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“…Increased HbA 1c represents long-term glucose regulation, whereas elevated glycemic excursion is not only a symptom of glucose dysregulation, but also of stress and general poor health. Carmen Wong et al found cortisol level is correlated with acute hyperglycaemia in patients with AMI [24]. There is a clear association to be found between HbA 1c and long-term outcome in AMI patients after 3.3 years follow-up [25].…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of early in-hospital glycemic excursion in elderly patients with acute myocardial infarction

Gong

Zhao

et al. 2013

Cardiovasc Diabetol

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BackgroundAcute phase hyperglycemia has been associated with increased mortality in patients with acute myocardial infarction (AMI). However, the predictive value of glycemic excursion for adverse outcome in elderly AMI patients is not clear. The aim of this study is to investigate the prognostic value of early in-hospital glycemic excursion and hemoglobin A1c (HbA1c) for one-year major adverse cardiac event (MACE) in elderly patients with AMI.MethodsWe studied 186 elderly AMI patients, whose clinical data were collected and the Global Registry of Acute Coronary Events (GRACE) risk score were calculated on admission. The fluctuations of blood glucose in patients were measured by a continuous glucose monitoring system (CGMS) for 72 hours. Participants were grouped into tertiles of mean amplitude of glycemic excursions (MAGE) and grouped into HbA1c levels (as ≥6.5% or <6.5%). The MACE of patients, including new-onset myocardial infarction, acute heart failure and cardiac death, was documented during one year follow-up. The relationship of MAGE and HbA1c to the incidence of MACE in elderly AMI patients was analyzed.ResultsIn all participants, a higher MAGE level was associated with the higher GRACE score (r = 0.335, p < 0.001). The rate of MACE by MAGE tertiles (>3.94 mmol/L, 2.55-3.94 mmol/L or <2.55 mmol/L) was 30.2% vs. 14.8% vs. 8.1%, respectively (p = 0.004); by HbA1c category (≥6.5% vs. <6.5%) was 22.7% vs. 14.4%, respectively (p = 0.148). Elderly AMI patients with a higher MAGE level had a significantly higher cardiac mortality. In multivariable analysis, high MAGE level was significantly associated with incidence of MACE (HR 3.107, 95% CI 1.190-8.117, p = 0.021) even after adjusting for GRACE risk score, but HbA1c was not.ConclusionsThe early in-hospital intraday glycemic excursion may be an important predictor of mortality and MACE even stronger than HbA1c in elderly patients after AMI.

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“…Wong et al. on the basis of the analysis of a subpopulation of patients from ‘The Hyperglycemia: Intensive Insulin Infusion In Infarction (HI‐5) Study’ postulate the pre‐existence of AGT and a stronger stress reaction in patients with a more serious disease course to be the basic mechanisms of stress hyperglycaemia occurrence in patients with MI (33). They base their conclusions on significantly higher cortisol values on admission in the group without AGT.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the study by Wong et al. did not take account of the time from pain onset to admission (33). Therefore, it is possible that the delay in the group without AGT was significantly shorter and for that reason higher cortisol concentrations were observed there.…”

Section: Discussionmentioning

confidence: 99%

Stress hyperglycaemia in patients with first myocardial infarction

Bronisz

Koziński

Magielski

et al. 2012

International Journal of Clinical Practice

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Newly detected AGT in patients with a first MI is transient in 50% of cases. Stress hyperglycaemia is a common finding in patients with a first MI with ST-segment elevation and diabetes mellitus, but is rarely observed in individuals with impaired glucose tolerance or transient AGT diagnosed during the acute phase of MI. The risk factors of stress hyperglycaemia occurrence include elevated HbA(1c) , anterior MI and high admission cortisol concentration.

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High cortisol levels in hyperglycaemic myocardial infarct patients signify stress hyperglycaemia and predict subsequent normalization of glucose tolerance

Cited by 22 publications

References 25 publications

Impact of Admission Glycemic Variability, Glucose, and Glycosylated Hemoglobin on Major Adverse Cardiac Events After Acute Myocardial Infarction

Impact of Admission Glycemic Variability, Glucose, and Glycosylated Hemoglobin on Major Adverse Cardiac Events After Acute Myocardial Infarction

Prognostic value of early in-hospital glycemic excursion in elderly patients with acute myocardial infarction

Stress hyperglycaemia in patients with first myocardial infarction

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