Sustained prognostic implications of newly detected glucose abnormalities in patients with acute myocardial infarction: Long-term follow-up of the Glucose Tolerance in Patients with Acute Myocardial Infarction cohort

Abstract

Objective: To investigate long-term prognostic importance of newly discovered glucose disturbances in patients with acute myocardial infarction (AMI). Methods: During 1998-2001, consecutive patients with AMI (n = 167) and healthy controls (n = 184) with no previously known diabetes were investigated with an oral glucose tolerance test (OGTT). Patients and controls were separately followed up for cardiovascular events (first of cardiovascular mortality/AMI/stroke/heart failure) during a decade. Results: In all, 68% of the patients and 35% of the controls had newly detected abnormal glucose tolerance (AGT). Cardiovascular event (n = 72, p = 0.0019) and cardiovascular mortality (n = 31, p = 0.031) were more frequent in patients with newly detected AGT. Regarding patients, a Cox proportional-hazard regression analysis identified AGT (hazard ratio (HR): 2.30; 95% confidence interval (CI): 1.24-4.25; p = 0.008) and previous AMI (HR: 2.39; CI: 1.31-4.35; p = 0.004) as prognostically important. Conclusion: An OGTT at discharge after AMI disclosed a high proportion of patients with previously unknown AGT which had a significant and independent association with long-term prognosis.

Four varieties of diabetes mellitus in acute myocardial infarction

“…OGTT at the discharge performed in the patients with AMI detected a high proportion of patients with previously unknown abnormal glycoregulation that was significantly and independently related to a dismal long-term prognosis 41 . Within 7 days following AMI, OGTT can detect many patients with previously unknown either newly detected DM or IGT, indicating a high risk for the CV events in the next decade.…”

“…OGTT has been often recommended for the AMI patients 23,25,26 . But neither from ADA 28 nor from NICE 40 , OGTT is a valid screening tool for both DM and a high CV risk 41 . OGTT in the patients with ACS has comparable accuracy to that in the general population.…”

Elevated levels of adipokines predict outcome after acute myocardial infarction: A long-term follow-up of the Glucose Tolerance in Patients with Acute Myocardial Infarction cohort

“…8 As a result, it is reasonable to assume that there is a connection or shared mechanism between the obesity and the adiponectin paradoxes. We recently demonstrated that individuals with glucose abnormalities newly discovered by OGTT at discharge from an AMI run a high CV risk during the following decade, 2 and that leptin is a predictor of CV events during a period of 3 years following an AMI in patients without previously known diabetes. 29 In this long-term follow-up, leptin remained a predictor of major CV events up to 7 years after AMI but did not predict total mortality contrary to the finding on adiponectin.…”

“…1 This is also true for individuals with newly discovered glucose abnormalities. 2 Biomarkers that are easily available in the acute setting of an acute coronary event are highly warranted to identify high-risk patients and could further elucidate underlying causes of the long-term risk. Adipokines, derived from the adipose tissue, such as adiponectin and leptin, are closely related to the metabolic syndrome and development of diabetes 3,4 where females have higher levels of adiponectin and leptin than men.…”

Testosterone, sex hormone-binding globulin and risk of cardiovascular events: A report from the Outcome Reduction with an Initial Glargine Intervention trial

“…Patients and controls were followed until December 31 2011, resulting in a median followup time of 11.6 and 10.4 years respectively (97). The primary endpoint was a composite of major CV events (first occurrence of CV death i.e.…”