Association of fasting blood glucose variability with all‐cause mortality in heart transplant recipients

Abstract

BackgroundFasting blood glucose (FBG) variability, an emerging marker of glycemic control, has been shown to be related to the risk of cardiovascular events and all‐cause mortality in subjects with or without diabetes. However, whether FBG variability is independently associated with a higher all‐cause mortality in heart transplant recipients remains unknown.MethodsWe performed a retrospective cohort study including 373 adult recipients who survived for at least 1 year after heart transplantation with a functioning graft and measured FBG more than three times within first year after transplantation. Multivariable adjusted Cox regression analyses were performed to assess the association between FBG variability and all‐cause mortality.ResultsPatients were categorized into three groups according to the coefficient of variation of FBG level: ≤7.0%, 7.0%–13.5%, and >13.5%. During a median follow‐up of 44.4 months (interquartile range [IQR], 22.6–63.3 months), 31 (8.3%) participants died. In univariate analyses, FBG variability was associated with an increased all‐cause mortality (hazard ratio [HR]: 3.00, 95% confidence interval [CI]: 1.67, 5.38; p < .001). This association remained materially unchanged in the multivariable model adjusted for components of demographics, cardiovascular history and lifestyle, hospital information, immunosuppressive therapy, and post‐transplant renal function (HR: 2.75, 95% CI: 1.43, 5.28; p = .004).ConclusionsAfter heart transplantation, high FBG variability is strongly and independently associated with an increased risk of all‐cause mortality. Our findings suggest that FBG variability is a novel risk factor and prognostic marker for heart transplantation recipients in outpatient clinic.

Impact of acute glycemic variability on short-term outcomes in patients with ST-segment elevation myocardial infarction: a multicenter population-based study

“…In DM and acute HF patients, higher GV was identi ed as the strongest independent predictor for mid-term MACEs [21]. In patients undergoing cardiac surgery, high acute GV has been linked to poor in-hospital outcomes [22,23]. Moreover, in the adult population, high GV associated with increased risk of atrial brillation [24].…”

Impact of acute glycemic variability on short-term outcomes in patients with ST-segment elevation myocardial infarction: a multicenter population-based study

“…In DM and acute HF patients, higher GV was identified as the strongest independent predictor for mid-term MACEs [ 21 ]. In patients undergoing cardiac surgery, high acute GV has been linked to poor in-hospital outcomes [ 22 , 23 ]. Moreover, in the adult population, high GV associated with increased risk of atrial fibrillation [ 24 ].…”

High blood glucose variability may predict poor outcomes in patients with spontaneous cerebellar hemorrhage undergoing surgical operation: a retrospective study

“…Recently, oxidative stress and inflammatory response have been increasingly recognized as important factors for the secondary brain damage after stroke [ 39 , 40 ]. Although sustained hyperglycemia promotes the expression of markers of oxidative stress, a fluctuating rise in BG corresponds to a more severe oxidative stress response [ 13 , 41 ]. Oxidative stress and inflammatory responses lead to impairment of endothelial function by increasing apoptosis of vascular endothelial cells [ 20 , 30 ].…”

“…Hyperglycemia is often associated with unfavorable outcomes in patients with acute critical illness, as is intracranial hemorrhage [ 10 – 12 ]. Most previous studies have focused on the relationship between absolute blood glucose (BG) levels at admission and clinical outcomes [ 13 , 14 ]. There are also researcher who reported that BG level at admission was not the independent risk factor for the prognosis of patients with cerebral hemorrhage [ 15 , 16 ].…”