Impact of HbA1c on Outcomes of Acute Coronary Syndrome in Non-Diabetic Patients
DOI:
https://doi.org/10.12970/2311-052X.2014.02.03.3Keywords:
HbA1c, Acute Coronary Syndrome.Abstract
Background: Elevated glucose levels have been previously shown to be associated with adverse outcomes in patients of acute coronary syndrome. However, admission glucose levels are affected by various factors like meals, circadian cycle and also the stress response. HbA1c is a better marker of long- term glucose status. The value of HbA1c as a predictor of prognosis in acute coronary syndrome has not been extensively studied.
Objective: To study the relationship between admission HbA1c levels and short-term outcome in non-diabetic patients admitted with acute coronary syndrome.
Material and Methods: This open-label, hospital based, cohort study was conducted on 200 patients without previously known diabetes admitted with acute coronary syndrome. A detailed history and clinical examination were carried out. Admission plasma glucose, fasting glucose and HbA1c levels were recorded. Those presenting with fasting plasma glucose of >126 mg% or HbA1c >6.5% were labeled as “Undiagnosed Diabetic Patients”. Outcome was measured mainly by assessing the left ventricular systolic function. Data were analysed using chi square test, student t-test, ANOVA and partial correlation regression, wherever applicable.
Results: Mean age of patients was 56.38 years. Average BMI was 25.1±3.5 kg/m2. Mean HbA1c was 6.3±1.5%. 79 (39.5%) patients had HbA1c between 6 and 6.5. There was a linear correlation between ejection fraction and HbA1c (p value =0.019).
Conclusion: HbA1c is a strong predictor of left ventricular dysfunction in non-diabetic patients presenting with acute coronary syndrome, therefore, measurement of HbA1c levels may improve risk assessment in patients presenting with acute coronary syndrome.
References
Kosiborod M, Rathore SS, et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 2005; 111: 3078-86. http://dx.doi.org/10.1161/CIRCULATIONAHA.104.517839
Shoaib Zaheer M, Uwais Ashraf M, et al. Prognostic importance of admission versus persistent glycemia in acute coronary syndrome. Diabetes Metab Syndr 2013; 7(1): 42-7. http://dx.doi.org/10.1016/j.dsx.2013.02.002
Goff DC Jr, Gerstein HC, et al. Prevention of Cardiovascular disease in persons with type 2 diabetes mellitus: Current knowledge and rationale for the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Am J Cardiol 2007; 99 (12A).
Garcia MJ, McNamara PM, Gordon T, Kannel WB. Morbidity and mortality in diabetes in the Framingham population. Diabetes 1974; 23: 105-16.
Haff ner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in non diabetic subjects with an without prior myocardial infarction. N Engl J Med 1998; 339: 229-34. http://dx.doi.org/10.1056/NEJM199807233390404
Gerstein HC. Glycosylated Hemoglobin. Finally ready for prime time as a cardiovascular risk factor. Ann Intern Med 2004; 141: 475-6. http://dx.doi.org/10.7326/0003-4819-141-6-200409210-00014
Cakmak M, Cakmak N, Cetemen S, et al. The value of admission glycosylated hemoglobin level in patients with acute myocardial infarction. Can J Cardiol 2008; 24: 375-8. http://dx.doi.org/10.1016/S0828-282X(08)70600-7
Bauters C, Ennezat PV, Tricot O, et al. Stress hyperglycaemia is an independent predictor of left ventricular remodeling after first anterior myocardial infarction in nondiabetic patients. Eur Heart J 2007; 28: 546-52. http://dx.doi.org/10.1093/eurheartj/ehl546
Selvin E, Marinopoulos S, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141(6): 421-31. http://dx.doi.org/10.7326/0003-4819-141-6-200409210-00007
Impaired vascular reactivity in insulin dependent diabetes mellitus is related to disease duration and low density lipoprotein cholesterol levels. J Am Coll Cardiol 1996; 28: 573-79. http://dx.doi.org/10.1016/0735-1097(96)82380-1
Davi G, Ciabattoni G, Consoli A, et al. In vivo formation of 8-iso-prostaglandin f2 alpha and platelet activation in diabetes mellitus: effects of improved metabolic control and vitamin E supplementation. Circulation 1999; 99: 224-9. http://dx.doi.org/10.1161/01.CIR.99.2.224
Razzaq MKA, Rasheed JI, Mohmmad HS. The Value of Admission Glucose and Glycosylated Hemoglobin in Patients with acute Coronary Syndrome. The Iraqi Postgraduate Medical 2013; 12(1).
Chan CY, et al. The Value of Admission HbA1c Level in Diabetic Patients With Acute Coronary Syndrome. Clin Cardiol 2011; 34(8): 507-12. http://dx.doi.org/10.1002/clc.20915
Mohsen J, Masoud A. Glycated Hemoglobin As a Predictor for Metabolic Syndrome in an Iranian Population with Normal Glucose Tolerance. Metabolic Syndrome & Related Disorders 2012; 10(6): 430.
Dilley J, Ganesan A, Deepa R, et al. Association of A1c with cardiovascular disease and metabolic syndrome in Asian Indians with normal glucose tolerance. Diabetes Care 2007; 30: 1527-32. http://dx.doi.org/10.2337/dc06-2414
Eriksson JW, Jansen P-A, Foley K, Lithell H. Insulin sensitivity following treatment with the alpha, blocker bunazosin retard and the beta-blocker atenolol in hypertensive non-insulin dependent diabetes mellitus patients. J Hypertens 1996; 14: 1469-75. http://dx.doi.org/10.1097/00004872-199612000-00014
Berne C, Pollare T, Lithell H. Effects of Antihypertensive Treatment on Insulin Sensitivity With Special Reference to ACE Inhibitors. Diabetes Care 1991; 14(11) suppl 4.
Mair J, Wagner I, Morass B, et al. Cardiac troponin I release correlates with myocardial infarction size. Eur J Clin Chem Clin Biochem 1995; 33(11): 869-72.
Burns RJ, Gibbons RJ, et al. The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis. J Am Coll Cardiol 2002; 39(1): 30-6. http://dx.doi.org/10.1016/S0735-1097(01)01711-9
