Oral glucose tolerance test predicts increased carotid plaque burden in patients with acute coronary syndrome

Abstract

BackgroundType 2 diabetes and prediabetes are established risk factors for atherosclerosis. The aim of this study was to evaluate the atherosclerotic plaque burden in the carotid arteries of patients with acute coronary syndrome according to their glycemic status.MethodsPatients with acute coronary syndrome and no previous history of type 2 diabetes were consecutively included in the study. Glucose metabolism was evaluated with fasting glucose in plasma, HbA1c and a standard two-hour oral glucose tolerance test. Atherosclerotic plaque in the carotid arteries was evaluated with a standardized ultrasound examination where total plaque area was measured and patients classified as having no plaque or a significant plaque formation.ResultsA total of 245 acute coronary syndrome patients (male 78%, 64 years (SD: 10.9)) were included. The proportion diagnosed with normal glucose metabolism, prediabetes and type 2 diabetes was 28.6%, 64.1% and 7.3%, respectively. A significant atherosclerotic plaque was found in 48.5%, 66.9% and 72.2% of patients with normal glucose metabolism, prediabetes and type 2 diabetes, respectively. An incremental increase in total plaque area was found from normal glucose metabolism to prediabetes (25.5%) and from normal glucose metabolism to type 2 diabetes (35.9%) (p = 0.04). When adjusted for conventional cardiovascular risk factors the OR of having significant atherosclerotic plaque in the carotid arteries was 2.17 (95% CI 1.15–4.15) for patients with newly diagnosed dysglycemia compared to patients with normal glucose metabolism. When additionally adjusted for the 2-hour plasma glucose after glucose loading (2hPG) the OR attenuated to 1.77 (95% CI 0.83–3.84).ConclusionNewly detected dysglycemia is an independent predictor of significant atherosclerotic plaque in the carotid arteries with oral glucose tolerance test as a major determinant of carotid plaque burden in this group of individuals with acute coronary syndrome.

Prediabetes Is Independently Associated with Subclinical Carotid Atherosclerosis: An Observational Study in a Non-Urban Mediterranean Population

“…In our study, the first to be conducted in a Mediterranean non-urban area, the prevalence of carotid plaque in prediabetes was lower than that observed in two other studies conducted in an urban area or in general population of Southern European regions (38% vs. 45–49%) [ 16 , 20 ]. In contrast, the reported frequency in urban areas of Japan and China was higher than that in our study (24–28% vs. 38%) [ 5 , 15 , 17 , 33 , 34 ]. These differences match previous epidemiologic studies of a lower CV risk profile in Asian populations, but do not agree with the higher frequency reported in rural vs. urban areas in Caucasian populations.…”

“…Regarding the study population, we included subjects younger than those of previous similar studies (mean age 50 years in our study vs. 57–68 years in others), which may be clearly associated with a lower CV risk in our case. Moreover, and most importantly, our study was conducted on subjects from the general population a priori free of CVD, while reports assessing individuals with CV risk factors or established CVD observed a much higher prevalence of carotid plaques in both control and prediabetic groups (44–53% and 49–79%, respectively) [ 5 , 17 , 20 , 34 ]. Regarding differences in US measurements, the definition of carotid plaque frequently varies between studies.…”

Atherosclerotic plaque development in mice is enhanced by myeloid ZEB1 downregulation

“…Disrupted glucose metabolism, as seen in conditions like prediabetes and type 2 diabetes, as well as impaired glucose tolerance following glucose loading, are linked to an elevated risk of carotid atherosclerosis 47 . Although Western diet-fed mice from both genotypes had similar levels of serum glucose (Supplementary Fig.…”

The prognostic effect of known and newly detected type 2 diabetes in patients with acute coronary syndrome

“…This may suggest that the dysglycemia could have remained undiagnosed for months or years before the acute event in these patients. 4 Whether previously known or newly detected, T2DM is associated with cardiovascular disease (CVD) and increased mortality in the general population. 5,6 Similarly, in patients with both stable coronary artery disease (CAD) and ACS, subgroups with an increased risk of future cardiovascular events have been identified based on a hyperglycemic response on a standard oral glucose tolerance test (OGTT).…”