BACKGROUND: Chronic hyperglycemia plays a role in the pathogenesis of coronary artery disease (CAD); however, the cut-off level beyond which glycemia becomes detrimental is still controversial. Postprandial glycemia may be a stronger CAD risk factor than fasting glycemia in patients without documented heart disease. OBJECTIVES: To identify the contributions of fasting and postprandial glycemia to cardiovascular risk in patients with documented coronary artery disease. METHODS: The Coronary Artery Surgery Study (CASS) registry is a database of 24,958 patients with suspected or proven CAD who underwent cardiac catheterization between 1974 and 1979. Median long-term follow up was 14.7 years (interquartile range 9.8 to 16.2 years). Clinical outcomes were evaluated according to fasting glucose levels and 2 h postprandial (postmeal) plasma glucose (2hPG) levels. A total of 13,176 patients with baseline fasting glucose levels and 1691 patients with 2hPG levels were identified. RESULTS: Impaired fasting glycemia was associated with a 1.2-fold increase in both all-cause and cardiovascular mortality (adjusted hazard ratio 1.23; 95% CI 1.08 to 1.40 for cardiovascular mortality), while undiagnosed diabetes was associated with a 1.5-fold increased risk for the same end points. Postprandial hyperglycemia (2hPG of 7.8 mmol/L to 11.0 mmol/L following an average meal) was not associated with a significant risk of death after adjustment for traditional risk factors or in the presence of fasting glucose of less than 6.1 mmol/L. CONCLUSIONS: In CAD patients, impaired fasting glucose is associated with increased all-cause and cardiovascular mortality, whereas postprandial hyperglycemia following an average meal does not appear to be a risk factor.
BACKGROUND:Chronic hyperglycemia plays a role in the pathogenesis of coronary artery disease (CAD); however, the cut-off level beyond which glycemia becomes detrimental is still controversial. Postprandial glycemia may be a stronger CAD risk factor than fasting glycemia in patients without documented heart disease. OBJECTIVES: To identify the contributions of fasting and postprandial glycemia to cardiovascular risk in patients with documented coronary artery disease. METHODS: The Coronary Artery Surgery Study (CASS) registry is a database of 24,958 patients with suspected or proven CAD who underwent cardiac catheterization between 1974 and 1979. Median long-term follow up was 14.7 years (interquartile range 9.8 to 16.2 years). Clinical outcomes were evaluated according to fasting glucose levels and 2 h postprandial (postmeal) plasma glucose (2hPG) levels. A total of 13,176 patients with baseline fasting glucose levels and 1691 patients with 2hPG levels were identified. RESULTS: Impaired fasting glycemia was associated with a 1.2-fold increase in both all-cause and cardiovascular mortality (adjusted hazard ratio 1.23; 95% CI 1.08 to 1.40 for cardiovascular mortality), while undiagnosed diabetes was associated with a 1.5-fold increased risk for the same end points. Postprandial hyperglycemia (2hPG of 7.8 mmol/L to 11.0 mmol/L following an average meal) was not associated with a significant risk of death after adjustment for traditional risk factors or in the presence of fasting glucose of less than 6.1 mmol/L. CONCLUSIONS: In CAD patients, impaired fasting glucose is associated with increased all-cause and cardiovascular mortality, whereas postprandial hyperglycemia following an average meal does not appear to be a risk factor.
Authors: Mehmet Baltali; Mehmet E Korkmaz; H Tarik Kiziltan; I Haldun Muderris; Bulent Ozin; Ruksan Anarat Journal: Int J Cardiol Date: 2003-04 Impact factor: 4.164
Authors: Joseph B Muhlestein; Jeffrey L Anderson; Benjamin D Horne; Farangis Lavasani; Chloe A Allen Maycock; Tami L Bair; Robert R Pearson; John F Carlquist Journal: Am Heart J Date: 2003-08 Impact factor: 4.749
Authors: Andreas Festa; Ralph D'Agostino; Anthony J G Hanley; Andrew J Karter; Mohammed F Saad; Steven M Haffner Journal: Diabetes Date: 2004-06 Impact factor: 9.461
Authors: E E Blaak; J-M Antoine; D Benton; I Björck; L Bozzetto; F Brouns; M Diamant; L Dye; T Hulshof; J J Holst; D J Lamport; M Laville; C L Lawton; A Meheust; A Nilson; S Normand; A A Rivellese; S Theis; S S Torekov; S Vinoy Journal: Obes Rev Date: 2012-07-11 Impact factor: 9.213