Two-hour post-challenge glucose is a better predictor of adverse outcome after myocardial infarction than fasting or admission glucose in patients without diabetes

Chattopadhyay, Sudipta; George, Anish; John, Joseph; Sathyapalan, Thozhukat

doi:10.1007/s00592-018-1114-2

Cited by 15 publications

(18 citation statements)

References 64 publications

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“…whereas each 1 mmol/L increase in FPG was associated with higher risk of MACE (28%) and cardiovascular mortality (51%) among post MI patients in UK; the risks however, were not significant in the models including both FPG and 2 h-PCPG [28]. The finding of the current study showed that each 1.04 mmol/L increase in FPG was associated with 16% and 17% higher risk of CVD and CHD, respectively.…”

Section: Discussioncontrasting

confidence: 60%

Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based study

Kabootari

Asgari

Ghavam

et al. 2020

Preprint

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Background: To assess the association between fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2h-PCPG) as continuous or categorical variables with risk of recurrent cardiovascular disease (CVD) and incident diabetes among subjects with history of previous CVD. Methods: In a prospective population-based cohort, a total of 335 Iranians aged ≥30 years, with history of CVD and free of known diabetes were included. Prediabetes was defined as impaired fasting glucose (IFG) according to the criteria of the American Diabetes Association (ADA) [IFG-ADA; FPG: 5.6-6.9 mmol/L], the World Health Organization (WHO) expert group (IFG-WHO; FPG: 6.1-6.9 mmol/L) and impaired glucose tolerance [IGT: 2h-PCPG: 7.8-11.0 mmol/L]. Cox’s proportional hazard models adjusted for traditional risk factors were used to estimate the hazard ratio (HR) with 95% confidence interval (CI) of different glucose intolerance for outcomes of interest. Results: During a median follow-up of 15.8 (IQR, 10.7-16.5) years, 178 CVD (hard event including death, myocardial infarction and stroke=69) events occurred. Regarding FPG, only IFG-ADA was associated with significant higher risk of hard CVD in the fully adjusted model (HR, 1.73, 95% CI: 1.04-2.89). Moreover, newly diagnosed diabetes (FPG≥7 mmol/L) was an independent risk of CVD (2.11: 1.22-3.66). Focusing on 2h-PCPG, subjects with newly diagnosed diabetes (2h-PCPG ≥ 11.1 mmol/L) had moderately increased risk of hard coronary heart disease (2.02:0.91-4.47, P=0.08). The multivariate HRs (95% CI) associated with 1 SD increase in FPG and 2h-PCPG was 1.16 (1.01–1.33) and 1.19 (1.02–1.38) for CVD, respectively. Among population free of diabetes at baseline (n=270), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes in multivariate analysis (all HRs > 4, P< 0.001); significant associations were also found for FPG and 2h-PCPG as continuous variables (all HRs for 1-SD increase > 2, all P < 0.001). Conclusions: Among subjects with stable CVD, both FPG and 2h-PCPG as continuous variables was associated with higher risk of recurrent CVD. However, only IFG-ADA was independent predictor of hard CVD events. Also, newly diagnosed diabetes, using FPG criteria, was associated with a significant risk of CVD. IFG-ADA, IFG-WHO and IGT were all significant predictors of incident diabetes.

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Section: Discussioncontrasting

confidence: 60%

Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based study

Kabootari

Asgari

Ghavam

et al. 2020

Preprint

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“…3,14 We have reported that 2h-PG was a better determinant of post-MI prognosis than FPG or APG. 13,21 In the EUORASPIRE IV 20 and Silent Diabetes Study, 27 2h-PG, but not FPG or HbA1c, was related to prognosis. The 2h-PG, but not the FPG, was associated with adverse post-MI prognosis in patients with pDM in this.…”

Section: Discussionmentioning

confidence: 97%

“…22 These tests under-diagnose dysglycaemia. 13 Undiagnosed pDM could add to the already high prognostic risk of this population and would affect the advice given to these patients. Thus, we wanted to explore whether (1) fasting and/or post-load hyperglycaemia below the threshold of DM affected post-MI prognosis, (2) FPG alone could identify this risk and (3) 2h-PG added any prognostic risk over and above FPG.…”

Section: Discussionmentioning

confidence: 99%

“…New diagnosis of pre-diabetes mellitus (pDM), i.e., impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), is common in patients after acute coronary syndrome (ACS) or myocardial infarction (MI). [1][2][3][4][5][6][7][8][9][10][11] Some of the studies [1][2][3][4][10][11][12][13][14] associating new diagnosed abnormal glucose tolerance (AGT) with adverse post-MI prognosis, report the effect of IGT separately. 11,12 IFG adversely affected post-ACS prognosis in some [5][6][7][8][9]15 but not other studies.…”

Section: Introductionmentioning

confidence: 99%

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Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes

Chattopadhyay

George

John

et al. 2019

Diabetes and Vascular Disease Research

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Background: Effect of pre-diabetes mellitus on post-myocardial infarction prognosis is unclear. Methods: Retrospective cohort analysis of 1056 myocardial infarction survivors with fasting plasma glucose and 2-h post-load plasma glucose measured. Major adverse cardiovascular events included death, non-fatal reinfarction and ischaemic stroke. Cox proportional hazard regression identified predictors of event-free survival. Continuous net reclassification improvement and integrated discrimination improvement determined the added predictive value of glycaemic indices. Results: Major adverse cardiovascular events occurred in 25.1% and 16.4% patients with and without pre-diabetes mellitus (hazard ratio with pre-diabetes mellitus: 1.56; 95% confidence interval: 1.17–2.08; p = 0.003) in the whole cohort and in 24.1% and 17.2% patients (hazard ratio with pre-diabetes mellitus, 1.43; 95% confidence interval: 1.03–1.98; p = 0.033) in the matched cohort, respectively. Pre-diabetes mellitus predicted major adverse cardiovascular events–free survival in whole (hazard ratio: 1.39; 95% confidence interval: 1.03–1.89; p = 0.033) and matched cohorts (hazard ratio: 1.42; 95% confidence interval: 1.01–1.99; p = 0.043). The 2-h post-load plasma glucose, but not fasting plasma glucose, predicted major adverse cardiovascular events–free survival in the whole (hazard ratio: 1.16; 95% confidence interval: 1.07–1.26; p < 0.0001) and matched cohorts (hazard ratio: 1.20; 95% confidence interval: 1.09–1.31; p < 0.0001). Adding 2-h post-load plasma glucose to models containing fasting plasma glucose, significantly improved net reclassification improvement and integrated discrimination improvement for both cohorts, but not vice versa. Conclusion: Pre-diabetes mellitus predicts major adverse cardiovascular events after myocardial infarction. The 2-h post-load plasma glucose predicts prognosis better than fasting plasma glucose in these patients.

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“…Evidence is accumulating that it is more important to find out whether CAD patients have dysglycaemia, defined as either IGT or T2DM, than to classify them as having either IGT or T2DM. 11,170 The latter is an arbitrary division that was introduced to distinguish people with dysglycaemia who had T2DM from those who ran a high risk of developing T2DM. 171 The present study adds new information by incorporating hospitalisation for heart failure in the primary endpoint, which traditionally only includes cardiovascular death, non-fatal MI and stroke.…”

Section: Prognostic Implications Of Indicators Of Dysglycaemiamentioning

confidence: 99%

The Accuracy of Point-of-Care Equipment for Glucose Measurement in Screening for Dysglycemia in Patients with Coronary Artery Disease

Shahim

Kjellström

Gyberg

et al. 2018

Diabetes Technology & Therapeutics

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Two-hour post-challenge glucose is a better predictor of adverse outcome after myocardial infarction than fasting or admission glucose in patients without diabetes

Abstract: AGT is under-diagnosed on current guidelines. 2h-PG is a better predictor of prognosis compared to APG and FPG.

Cited by 15 publications

References 64 publications

Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based study

Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based study

Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes

The Accuracy of Point-of-Care Equipment for Glucose Measurement in Screening for Dysglycemia in Patients with Coronary Artery Disease

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