Abstract 9796: Association of Unrecognized Myocardial Infarctions With Impaired Fasting Glucose in the Multi-Ethnic Study of Atherosclerosis

Background: It has been estimated that approximately 25% of initial myocardial infarctions (MI) are unrecognized (UMI). The prognostic implications of UMI’s have been shown to be as severe as those of symptomatic MI’s. Risk factors for UMI’s are not well understood. Because diabetes mellitus is known to be a risk factor for UMI, it is reasonable to investigate impaired fasting glucose (IFG) as a candidate risk factor. Additionally, it has recently been estimated that up to one-third of all adult Americans have IFG. Methods: The relationship between IFG and UMI was examined in the Multi-Ethnic Study of Atherosclerosis (MESA): a cohort of individuals aged 45 to 84 years without clinical cardiovascular disease. At baseline, participants with normal fasting glucose (NFG; n = 4955) and IFG (n=930) underwent a baseline 12-lead electrocardiogram (ECG). Using Minnesota code, an UMI was identified by the presence of pathological Q waves or minor Q waves with ST-T abnormalities. Crude and adjusted odds ratios (ORs) were calculated. Logistic regression was used to adjust for covariates in 2 models. Model 1 adjusted for age, race, gender, and body mass index. Model 2 adjusted for model 1 + systolic blood pressure, diastolic blood pressure, anti-hypertensive medication use, total cholesterol, HDL cholesterol, lipid-lowering medication use, and cigarette use. Results: The sample was 46% male, 41% white, 26% black, 20% Hispanic, and 12% Asian. There were 72 UMIs identified in the normal fasting glucose (NFG) subjects and 30 UMIs among the IFG subjects. The two corresponding prevalences (1.4% vs. 3.2%) resulted in a crude OR for UMI of 2.26 (95% Confidence Interval (CI): 1.47-3.48; p<0.001). With model 1 adjustments, the OR for UMI in IFG compared with NFG was 1.78 (95% CI: 1.12-2.8; p=0.015). With further adjustments in model 2, this relationship remained significant (OR: 1.63 (95% CI: 1.02-2.56); p=0.041). Conclusion: Unrecognized myocardial infarctions by electrocardiogram are associated with impaired fasting glucose in a population without overt cardiovascular disease. Because of the high prevalence of impaired fasting glucose, the implications of this finding may have ramifications for a large proportion of the adult population.

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Abstract 13272: High Density Lipoprotein Subclasses Predict Non-Cardiovascular Disease, Non-Cancer Chronic Inflammatory-Related Death and Hospitalization More Strongly than Cardiovascular Disease Events in the Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.130.suppl_2.13272 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Daniel Duprez ◽

James Otvos ◽

Kenneth Feingold ◽

Philip Greenland ◽

Myron D Gross ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

High Density Lipoprotein ◽

Inflammatory Markers ◽

Density Lipoprotein ◽

High Density ◽

Lipid Lowering ◽

Ethnic Study ◽

Lipoprotein Particles ◽

D Dimer

In vitro studies have demonstrated that high density lipoprotein particles (HDL-P) antagonize inflammatory processes. We studied the predictive value of HDL-P and inflammatory markers for incident cardiovascular disease (CVD) and non-CVD, non-cancer, chronic inflammatory-related events. Methods: In the Multi-Ethnic Study of Atherosclerosis, we studied 6475 men and women free of overt CVD, baseline age 45-84 years, who had fasting venous samples for lipid profile, lipoprotein particles, and inflammatory markers Interleukin-6 (IL-6), hs-CRP and D-dimer at baseline. Median follow-up was 10.1 years. Poisson regression models predicted non-CVD, non-cancer, chronic inflammatory-related events (death and hospitalization), based on diagnostic codes, n=1054) and CVD events due to coronary heart disease, myocardial infarction, coronary artery disease requiring revascularization, stroke, peripheral arterial disease, congestive heart failure and CVD or unwitnessed death (adjudicated, n=756). Adjustment was for age, race, gender, clinic, heart rate, smoking, body mass index, blood pressure, blood pressure and lipid lowering medication, diabetes mellitus, plus all lipid, lipoprotein particle and inflammatory variables. Results: Non-CVD, non-cancer, chronic inflammatory-related events were inversely associated with the sum of small+medium HDL-P independent of covariates (relative risk (RR) per standard deviation (95% confidence limits), RR: 0.85 (0.79-0.91, P < 0.0001). Non-CVD, non-cancer, chronic inflammatory-related events were positively associated with IL-6, RR:1.19 (1.11-1.27, P < 0.0001) and D-dimer, RR: 1.10 (1.05-1.16, P < 0.0001). CVD was associated with small+medium HDL-P, RR: 0.90 (0.82-0.99, P < 0.03) and IL-6, RR:1.15 (1.06-1.25 P < 0.0001). hsCRP was unrelated to either outcome after adjustment for other inflammatory markers. Conclusion: The long-term inverse association of small+medium HDL-P with non-CVD, non-cancer, chronic inflammatory-related death and hospitalization was stronger than with fatal and non-fatal CVD in subjects initially free of overt CVD. These findings provide clinical evidence that small+medium HDL-P have anti-inflammatory properties and may rethink the importance of HDL-P beyond CVD.

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Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study

Diabetes Care ◽

10.2337/diacare.22.6.920 ◽

1999 ◽

Vol 22 (6) ◽

pp. 920-924 ◽

Cited By ~ 788

Author(s):

M. Tominaga ◽

H. Eguchi ◽

H. Manaka ◽

K. Igarashi ◽

T. Kato ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Impaired Fasting Glucose ◽

Fasting Glucose

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Impaired Fasting Glucose, Blood Pressure and Cardiovascular Disease Mortality

Hypertension ◽

10.1161/01.hyp.0000032853.95690.26 ◽

2002 ◽

Vol 40 (4) ◽

pp. 458-463 ◽

Cited By ~ 66

Author(s):

Patrick Henry ◽

Frédérique Thomas ◽

Athanase Benetos ◽

Louis Guize

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Impaired Fasting Glucose ◽

Fasting Glucose ◽

Cardiovascular Disease Mortality ◽

Disease Mortality

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Abstract 16000: Impaired Fasting Glucose Increases Risk for an Unrecognized Myocardial Infarction: The Cardiovascular Health Study

Circulation ◽

10.1161/circ.132.suppl_3.16000 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Richard B Stacey ◽

Paul E Leaverton ◽

Douglas D Schocken ◽

Jennifer Peregoy ◽

Mary Lyles ◽

...

Keyword(s):

Myocardial Infarction ◽

Risk Factor ◽

Impaired Fasting Glucose ◽

Cardiovascular Health ◽

Fasting Glucose ◽

Medication Use ◽

Health Study ◽

Cardiovascular Health Study ◽

Electrocardiogram Ecg ◽

The Relationship

Background: Almost 25% of initial myocardial infarctions (MI) are unrecognized or clinically-silent (UMI). The prognostic implications of a UMI parallel those of symptomatic MIs. With diabetes mellitus (DM) being a known risk factor for UMI, further investigation is warranted regarding impaired fasting glucose (IFG) as a risk factor for UMI. Up to one-third of Americans have IFG . Therefore the relationship between UMI and IFG may have significant public health and clinical ramifications. Methods: The relationship between IFG and UMI was examined in the Cardiovascular Health Study: a cohort of individuals aged ≥ 65 years old. At year 2, there were 5,018 participants who had an initial 12-lead electrocardiogram (ECG). Of these participants, those with prior coronary heart disease (CHD), incident CHD, or a UMI on initial ECG were excluded. Our study population consisted of 1,714 participants without exclusions with measured fasting glucose (normal fasting glucose, NFG; n = 844), IFG (n=679), and DM (n=191) who underwent a baseline 12-lead electrocardiogram (ECG). Using Minnesota code, an UMI was identified by the presence of pathological Q waves or minor Q waves with ST-T abnormalities. Crude and adjusted hazard ratios (HRs) were calculated. Cox proportional hazard models were used to adjust for age, gender, body mass index, hypertension, anti-hypertensive medication use, total cholesterol, HDL cholesterol, lipid-lowering medication use, and cigarette use. Results: The sample was 36% male, 95% white, and had a mean age of 72.4 ± 5.6 years. Over a mean follow-up of 8.1 years, there were 94 UMIs identified among NFG subjects, 110 among IFG subjects, and 35 among DM subjects. Relative to NFG, the crude risk ratio estimates for UMI with IFG and DM were 1.53 (95% CI: 1.16-2.01) and 1.85 (1.24-2.70), respectively. With adjustment, the HR for UMI in IFG compared with NFG was 1.37 (95% CI: 1.03-1.83; p=0.032), and the HR for UMI in DM compared with NFG was 1.59 (95% CI: 1.24-2.70; p=0.035). Conclusion: Impaired fasting glucose increased the risk for a subsequent unrecognized myocardial infarction. Considering the enormous number of individuals at risk, these findings suggest the need for more aggressive CVD prevention activities.

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Impaired Fasting Glucose alone or in combination with Hypertension, Dyslipidemia, or both AND Major Adverse Cardiovascular Events among patients without previous cardiovascular disease.

10.21203/rs.2.10473/v2 ◽

2019 ◽

Author(s):

Nahid Hashemi Madani ◽

Faramarz Ismail-Beigi ◽

Hossein Poustchi ◽

Mahdi Nalini ◽

Sadaf G. Sepanlou ◽

...

Keyword(s):

Cardiovascular Disease ◽

Impaired Fasting Glucose ◽

Cardiovascular Events ◽

Fasting Glucose ◽

Population Based ◽

Major Adverse Cardiovascular Events ◽

Cox Proportional Hazard ◽

Normal Fasting Glucose ◽

Cox Proportional Hazard Models

Abstract Background Whether pre-diabetes in the absence of hypertension (HTN) or dyslipidemia (DLP) is a risk factor for occurrence of major adverse cardiovascular events (MACE) is not fully established. We investigated the effect of impaired fasting glucose (IFG) alone and in combination with HTN, DLP or both on subsequent occurrence of MACE as well as individual MACE components. Methods This longitudinal population-based study included 9,831 inhabitants of Northeastern Iran. The participants were free of any cardiovascular disease at baseline and were followed yearly from 2010 to 2017. Cox proportional hazard models were fitted to measure the hazard of IFG alone or in combination with HTN and DLP on occurrence of MACE as the primary endpoint. Results 297 MACE were recorded during 6.2±0.1 years follow up. IFG alone compared to normal fasting glucose (NFG) was not associated with increased in occurrence of MACE (HR, 1.05; 95% CI, 0.59-1.86; p, 0.8). However, combination of IFG and HTN (HR, 2.75; 95% CI, 1.93-3.90; p, 0.001) or HTN + DLP (HR, 2.85; 95% CI, 1.79-4.54; p, 0.001) significantly increased the hazard of MACE. In contrast, IFG with DLP at baseline did not increase the hazard of MACE compared to normoglycemic- normolipemic individuals (p,0.2). The results also indicated IFG with HTN, DLP, or HTN+DLP were associated with significant higher HRs for some individual components of MACE. Conclusion IFG, per se, does not appear to increase hazard of MACE. However, IFG with HTN or HTN + DLP conferred a significant hazard for MACE in an incremental manner.

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B-Vitamins, Methylenetetrahydrofolate Reductase (MTHFR) and Hypertension

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000069 ◽

2011 ◽

Vol 81 (4) ◽

pp. 240-244 ◽

Cited By ~ 14

Author(s):

Mary Ward ◽

Carol P Wilson ◽

J J Strain ◽

Geraldine Horigan ◽

John M. Scott ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Factor ◽

Low Dose ◽

Methylenetetrahydrofolate Reductase ◽

Genetic Determinant ◽

Gene Encoding ◽

Homocysteine Concentration ◽

Homozygous Mutant ◽

B Vitamin

Hypertension is a leading risk factor for cardiovascular disease (CVD) and stroke. A common polymorphism in the gene encoding the enzyme methylenetetrahydrofolate reductase (MTHFR), previously identified as the main genetic determinant of elevated homocysteine concentration and also recognized as a risk factor for CVD, appears to be independently associated with hypertension. The B-vitamin riboflavin is required as a cofactor by MTHFR and recent evidence suggests it may have a role in modulating blood pressure, specifically in those with the homozygous mutant MTHFR 677 TT genotype. If studies confirm that this genetic predisposition to hypertension is correctable by low-dose riboflavin, the findings could have important implications for the management of hypertension given that the frequency of this polymorphism ranges from 3 to 32 % worldwide.

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