In-hospital death in acute coronary syndrome was related to admission glucose in men but not in women

Takada, Julio Yoshio; Ramos, Rogério Bicudo; Roza, Larissa Cardoso; Avakian, Solange Desirée; Ramires, José Antônio Franchini; Mansur, Antônio de Pádua

doi:10.1186/1475-2840-11-47

Cited by 16 publications

(10 citation statements)

References 42 publications

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“…In women, risk of myocardial infarction is more sensitive to blood glucose levels than that in men (47), with a stronger correlation between hyperglycemia and acute event mortality in diabetic females (137). However, high fasting blood glucose is more event-predictive for men than women (174,202), consistent with the observation that lower levels of hyperglycemia may be of more pathologic significance in females. Lipid metabolic disturbances and coincident hypertension appear accentuated in diabetic women, potentially contributing to greater cardiac risk (30,80).…”

Section: Clinical Contextsupporting

confidence: 64%

Sex, sex steroids, and diabetic cardiomyopathy: making the case for experimental focus

Reichelt

Mellor

Bell

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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More than three decades ago, the Framingham study revealed that cardiovascular risk is elevated for all diabetics and that this jeopardy is substantially accentuated for women in particular. Numerous studies have subsequently documented worsened cardiac outcomes for women. Given that estrogen and insulin exert major regulatory effects through common intracellular signaling pathways prominent in maintenance of cardiomyocyte function, a sex-hormone:diabetic-disease interaction is plausible. Underlying aspects of female cardiovascular pathophysiology that exaggerate cardiovascular diabetic risk may be identified, including increased vulnerability to coronary microvascular disease, age-dependent impairment of insulin-sensitivity, and differential susceptibility to hyperglycemia. Since Framingham, considerable progress has been made in the development of experimental models of diabetic disease states, including a diversity of genetic rodent models. Ample evidence indicates that animal models of both type 1 and 2 diabetes variably recapitulate aspects of diabetic cardiomyopathy including diastolic and systolic dysfunction, and cardiac structural pathology including fibrosis, loss of compliance, and in some instances ventricular hypertrophy. Perplexingly, little of this work has explored the relevance and mechanisms of sexual dimorphism in diabetic cardiomyopathy. Only a small number of experimental studies have addressed this question, yet the prospects for gaining important mechanistic insights from further experimental enquiry are considerable. The case for experimental interrogation of sex differences, and of sex steroid influences in the aetiology of diabetic cardiomyopathy, is particularly compelling-providing incentive for future investigation with ultimate therapeutic potential.

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Section: Clinical Contextsupporting

confidence: 64%

Sex, sex steroids, and diabetic cardiomyopathy: making the case for experimental focus

Reichelt

Mellor

Bell

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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“…Stress hyperglycaemia is common in acute myocardial infarction, whereas increased catecholamine levels result in decreased insulin secretion and increased insulin resistance [ 29 ]. Although stress-induced hyperglycaemia could partly explain the relation between admission GV and outcomes, especially for AMI patients, glycemic excursion itself can also be harmful.…”

Section: Discussionmentioning

confidence: 99%

Effect of glycemic variability on short term prognosis in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

Zhang

Ling

Cao

et al. 2014

Diabetol Metab Syndr

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ObjectiveGlycemic variability (GV) still remains unclear whether acute glycemic excursion has the important prognostic significance in ST-segment elevation myocardial infarction (STEMI) patients undergoing p-PCI. So our aim is to assess the prognostic value of GV in STEMI patients undergoing p-PCI.MethodsWe studied 237 STEMI patients undergoing p-PCI, whose clinical and laboratory data were collected. We used a continuous glucose monitoring system (CGMS) to measure the fluctuations of blood glucose. Participants were grouped into diabetes group and non-diabetes group, and grouped into tertiles of mean amplitude of glycemic excursions (MAGE). The major adverse cardiac events (MACE) of patients was documented during in-hospital and 30-day follow-up. The relationship of MAGE and the incidence of MACE were analyzed.ResultsData from 237 subjects were incorporated into the statistical analysis, a higher MAGE level was associated with the higher peak CK-MB values (r = 0.374, P <0.01), and the higher peak cTnI values (r = 0.410, P <0.01). The rate of composite MACE by MAGE tertiles (<2.37 mmol/l, 2.37-3.65 mmol/l and >3.65 mmol/l) was 7.5% vs. 14.1% vs. 22.8%, respectively (P = 0.025); STEMI patients with a higher MAGE level had a significantly higher non-IRA revascularization compared with those with lower MAGE levels (32% vs. 15% vs. 21%, P = 0.037). Moreover, diabetic patients with higher MAGE level had significantly higher incidence of composite MACE and non-IRA revascularization, non-diabetic subjects did not show the similar results. In multivariable logistic analysis, the independent predictors of MACE were: MBG, MAGE and LVEF in diabetic subjects and were MBG and MAGE in nondiabetic subjects. Other factors were not significantly associated with MACE.ConclusionsGreater GV is associated with composite MACE and non-IRA revascularization during in-hospital and 30-day follow-up in unadjusted analyses, especially for diabetic subjects. After multivariable logistic analysis, GV remains an independent prognostic factor for composite MACE in STEMI patients undergoing p-PCI.

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“…Acute hyperglycaemia is a common acute adrenergic signal of stress and is present in myocardial infarction, whereas increased catecholamine levels result in decreased insulin secretion and increased insulin resistance [20]. Although stress-induced hyperglycaemia can partly explain the relation between admission glycemic variability and outcomes, glycemic excursion itself can also be harmful.…”

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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In-hospital death in acute coronary syndrome was related to admission glucose in men but not in women

Cited by 16 publications

References 42 publications

Sex, sex steroids, and diabetic cardiomyopathy: making the case for experimental focus

Sex, sex steroids, and diabetic cardiomyopathy: making the case for experimental focus

Effect of glycemic variability on short term prognosis in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

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

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