Abnormal Glucose Metabolism in Acute Myocardial Infarction

Høfsten, Dan Eik; Løgstrup, Brian Bridal; Møller, Jacob Eifer; Pellikka, Patricia A.; Egstrup, Kenneth

doi:10.1016/j.jcmg.2009.03.007

Cited by 33 publications

(12 citation statements)

References 22 publications

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“…According to the OGTT, 35% and 40% had impaired glucose tolerance at discharge and after 3 months, respectively and 31% and 25% had previously undiagnosed diabetes [11]. Similar results were also found by Egstrup et al [2,14]. …”

Section: Discussionsupporting

confidence: 76%

Temporal trends in the initiation of glucose-lowering medications after a first-time myocardial infarction - a nationwide study between 1997 and 2006

Nørgaard

Andersson

Hansen

et al. 2011

Cardiovasc Diabetol

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BackgroundType 2 diabetes is a well-established risk factor for cardiovascular disease and is common among patients with acute myocardial infarction (MI). The extent to which patients with first-time MI develop diabetes requiring glucose-lowering medications (GLM) is largely unknown. The aim of the study was to investigate temporal trends in the initiation of GLM among patients discharged after first-time MI.MethodsAll Danish residents aged ≥ 30 years without prior diabetes hospitalized with first-time MI between 1997 and 2006 were identified by individual-level-linkage of nationwide registers. Initiation of GLM during follow-up was assessed by claimed prescriptions from pharmacies. Temporal trends in initiation of GLM were assessed by incidence rate calculations in the MI population as in the general population. Multivariable Cox proportional-hazard models were used to investigate the likelihood of initiating GLM within a year post-MI.ResultsThe population comprised 66,788 patients. Among these patients 3962 patients initiated GLM, of whom 1567 started within one year post-MI. An increase in incidence rates of GLM initiation in the MI population from 19.6 per 1000 person years in 1997 to approximately 27.6 in 2001 was demonstrated. After 2001 the incidence rates stabilized. A similar trend was observed in the general population where the incidence rates increased from 2.8 in 1997 to 4.0 in 2004 and then stabilized.ConclusionOur study demonstrated an increase in incidence rates of GLM initiation within the first year post- MI. A similar trend was observed in the general population suggesting that the increase in GLM among MI patients was primarily the effect of a general increased awareness of diabetes. From a public heath perspective, this study underscores a continuous need for diagnostic and therapeutic improvement in the care of MI patients that develop diabetes.

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Section: Discussionsupporting

confidence: 76%

Temporal trends in the initiation of glucose-lowering medications after a first-time myocardial infarction - a nationwide study between 1997 and 2006

Nørgaard

Andersson

Hansen

et al. 2011

Cardiovasc Diabetol

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“…First, hyperglycemia may play an important role by several pathophysiological mechanisms [24-27]. Secondly, these patients have higher HR [28].…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of admission heart rate in patients with ST-segment elevation myocardial infarction: Role of Type 2 diabetes mellitus

Han

Yang

Zhu

et al. 2012

BMC Cardiovasc Disord

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BackgroundIt’s unknown whether the prognostic value of admission heart rate (HR) was different in patients with ST-segment elevation myocardial infarction (STEMI) with or without concomitant type 2 diabetes mellitus (T2DM).MethodsConsecutive STEMI patients who presented within 12 hours of symptom onset were recruited from 274 hospitals in China. Participants were stratified into quartiles by admission HR. Baseline characteristics, current therapeutic recommenda- tions, laboratory biochemical tests, 30-day all-cause mortality and Cardiovascular Events (CVE, including all-cause death, reinfarction and stroke) were compared across admission HR quartiles.ResultsWe evaluated 7294 STEMI patients, of these 820 (11.2%) had known T2DM. The admission HR quartile stratification was significantly associated with all-cause mortality and CVE regardless of T2DM status (P < 0.001 both for survival and CVE). After adjusted other risk factors, in patients without T2DM, comparing with HR <66 b.p.m., the increase of HR level was associated with worse prognosis (P < 0.05). In patients with T2DM, the hazard ratios for 30-day CVE were 1.75 (95%CI), 1.92 (95%CI), 3.00 (95%CI) in the HR of 66–76 b.p.m., 77–88 b.p.m., and >88 b.p.m., respectively. Results were similar for 30-day all-cause mortality, but the hazard ratios in Q2 (P = 0.139 and P =0.086 for survival and CVE, respectively) and Q3 groups were non-significant (P = 0.072 and P =0.033 for survival and CVE, respectively). There was a significant interaction effect of HR and T2DM on 30-day CVE mortality (P = 0.035), which was not found on all-cause mortality (P = 0.126).ConclusionAdmission heart rate was an important risk factor of 30-day all-cause mortality and CVE in patients with STEMI with or without T2DM. However, the predictive effect was modified by T2DM.

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“…In our study, 69% of the total study population was diagnosed with abnormal glucose tolerance or had a prestudy diagnosis of DM. Patients with AMI with hospital-related hyperglycemia have an increased risk of both short- and long-term mortality and heart failure [2,26,27]. Moreover, several studies have demonstrated that hyperglycemia is associated with microvascular and endothelial dysfunction [5,28], increased oxidative stress [29], and an elevated inflammatory response in patients with AMI [3,29].…”

Section: Discussionmentioning

confidence: 99%

“…Abnormal glucose tolerance is encountered in up to 60% of patients with acute myocardial infarction (AMI), and it is associated with increased long-term morbidity and mortality [1,2]. Hyperglycemia is believed to initiate a chain of adverse reactions, with damaging effects on the cardiovascular system including endothelial dysfunction, inflammation, and oxidative stress [3].…”

Section: Objectivesmentioning

confidence: 99%

Effects of Intensive Statin Therapy on Left Ventricular Function in Patients with Myocardial Infarction and Abnormal Glucose Tolerance

Auscher

Løgstrup

Møller³

et al. 2017

Cardiology

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Objectives: Abnormal glucose tolerance in patients with acute myocardial infarction (AMI) is associated with greater mortality and adverse cardiovascular effects. As statins possess a range of beneficial pleiotropic effects on the cardiovascular system, we sought to assess the cardioprotective effects of statins on left ventricular function in patients with AMI in relation to glycometabolic state. Methods: In a prospective, randomized trial, 140 patients with AMI were randomized to intensive statin therapy receiving statin loading with 80 mg of rosuvastatin followed by 40 mg daily or standard statin therapy. Patients were assessed with an oral glucose tolerance test and their left ventricular (LV) function was assessed with speckle-tracking echocardiography measuring regional longitudinal systolic strain (RLSS) in the infarct area. Results: Overall RLSS in the infarct area improved by a mean (±SD) of -4.22% (±5.19) in the intensive-care group and -2.48% (±4.01) in the usual-care group after 1 month (p = 0.047). In patients with abnormal glucose tolerance, RLSS improved by -5.01% (±5.28) in the intensive-care group and -2.15% (±4.22) in the usual-care group (p = 0.01). Conclusions: Early high-dose statin treatment improved RLSS in the infarct area in patients with AMI, and a trend of greater improvement was seen in patients with abnormal glucose tolerance.

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Abnormal Glucose Metabolism in Acute Myocardial Infarction

Abstract: Although perturbations in glucose metabolism were linearly associated with impairment of LV function in the early phase of acute myocardial infarction, this relationship alone did not explain the excess mortality in patients with newly detected or known diabetes.

Cited by 33 publications

References 22 publications

Temporal trends in the initiation of glucose-lowering medications after a first-time myocardial infarction - a nationwide study between 1997 and 2006

Temporal trends in the initiation of glucose-lowering medications after a first-time myocardial infarction - a nationwide study between 1997 and 2006

Prognostic value of admission heart rate in patients with ST-segment elevation myocardial infarction: Role of Type 2 diabetes mellitus

Effects of Intensive Statin Therapy on Left Ventricular Function in Patients with Myocardial Infarction and Abnormal Glucose Tolerance

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