scholarly journals Admission fasting plasma glucose is associated with in-hospital outcomes in patients with acute coronary syndrome and diabetes: findings from the Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project

2020 ◽  
Author(s):  
Nan Ye ◽  
Lijiao Yang ◽  
Guoqin Wang ◽  
Weijing Bian ◽  
Fengbo Xu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Hospital Outcomes ◽  
Coronary Syndrome ◽  
Fasting Plasma ◽  
Increased Risk

Abstract BackgroundThe discrepancy between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in clinical practice may be related to factors such as acute stress, renal dysfunction, and anemia, and its relationship with in-hospital outcomes is uncertain. The aim of this study was to investigate the association between the type of discrepancy between HbA1c and FPG and in-hospital outcomes in patients with acute coronary syndrome (ACS) and diabetes.MethodsThe Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project is a national, hospital-based quality improvement project with an ongoing database. Patients with ACS, diabetes and complete HbA1c and FPG values at admission were included. The consistent group included patients with HbA1c < 6.5% and FPG < 7.0 mmol/L or HbA1c ≥ 6.5% and FPG ≥ 7.0 mmol/L. The discrepancy group included patients with HbA1c ≥ 6.5% and FPG < 7.0 mmol/L (increased HbA1c group) or HbA1c < 6.5% and FPG ≥ 7.0 mmol/L (increased FBG group).ResultsA total of 7,762 patients were included in this study. The numbers of patients in the consistent and discrepancy groups were 5,490 and 2,272 respectively. In the discrepancy group, increased HbA1c accounted for 77.5% of discrepancies, and increased FPG accounted for 22.5% of discrepancies. After adjusting for confounders, patients in the increased FPG group had a 1.6-fold increased risk of heart failure (OR, 1.62; 95% CI, 1.08-2.44), a 1.6-fold increased risk of composite cardiovascular death and heart failure (OR, 1.63; 95% CI, 1.09-2.43), and a 1.6-fold increased risk of composite major adverse cardiovascular and cerebrovascular events (MACCEs) and heart failure (OR, 1.56; 95% CI, 1.08-2.24) compared to patients in the increased HbA1c group.Conclusions Patients with an increased FPG but normal HbA1c had a higher risk of in-hospital adverse outcomes than those with increased HbA1c but normal FPG.This result may indicate that when HbA1c and FPG are inconsistent in patients with ACS and diabetes, the increased FPG that may be caused by stress hyperglycemia may have a more substantial adverse effect than increased HbA1c, which may be caused by chronic hyperglycemia. These high-risk patients should be given more attention and closer monitoring in clinical practice.

scholarly journals Type of discrepancy between glycosylated hemoglobin and fasting plasma glucose is associated with in-hospital outcomes in patients with acute coronary syndrome and diabetes: findings from the Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) Project

2020 ◽  
Author(s):  
Nan Ye ◽  
Lijiao Yang ◽  
Guoqin Wang ◽  
Weijing Bian ◽  
Fengbo Xu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Plasma Glucose ◽  
Glycosylated Hemoglobin ◽  
Hospital Outcomes ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Consistent Group

Abstract Background The discrepancy between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in clinical practice may be related to factors such as acute stress, renal dysfunction, and anemia, and its relationship with in-hospital outcomes is uncertain. The aim of this study is to investigate the association between the type of discrepancy between HbA1c and FPG and in-hospital outcomes in patients with acute coronary syndrome (ACS) and diabetes. Methods The Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project is a national, hospital-based quality improvement project with an ongoing database. Patients with ACS, diabetes and complete HbA1c and FBG values at admission were included. The consistent group included patients with HbA1c < 6.5% and FBG < 7.0 mmol/L or HbA1c ≥ 6.5% and FBG ≥ 7.0 mmol/L. The discrepancy group included patients with HbA1c ≥ 6.5% and FBG < 7.0 mmol/L (increased HbA1c group) or HbA1c < 6.5% and FBG ≥ 7.0 mmol/L (increased FBG group). Results A total of 7,762 patients were included in this study. The numbers of patients in the consistent group and discrepancy group were 5,490 and 2,272 respectively. In the discrepancy group, increased HbA1c accounted for 77.5% of discrepancies, and increased FPG accounted for 22.5% of discrepancies. After adjusting for confounders, patients in the increased FPG group had a 1.6-fold increased risk of heart failure (OR, 1.62; 95% CI, 1.08–2.44), a 1.6-fold increased risk of composite cardiovascular death and heart failure (OR, 1.63; 95% CI, 1.09–2.43), and a 1.6-fold increased risk of composite major adverse cardiovascular and cerebrovascular events (MACCEs) and heart failure (OR, 1.56; 95% CI, 1.08–2.24). Conclusions Patients with an increased FPG but normal HbA1c had a higher risk of in-hospital adverse outcomes than those with increased HbA1c but normal FPG. This result may indicate that when HbA1c and FPG are inconsistent in patients with ACS and diabetes, the increased FPG that may be caused by stress hyperglycemia may have a more substantial adverse effect than increased HbA1c, which may be caused by chronic hyperglycemia. These high-risk patients should be given more attention and closer monitoring in clinical practice.

scholarly journals Type of discrepancy between glycosylated hemoglobin and fasting plasma glucose is associated with in-hospital outcomes in patients with acute coronary syndrome and diabetes: findings from the Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) Project

2020 ◽  
Author(s):  
Nan Ye ◽  
Lijiao Yang ◽  
Guoqin Wang ◽  
Weijing Bian ◽  
Fengbo Xu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Plasma Glucose ◽  
Glycosylated Hemoglobin ◽  
Hospital Outcomes ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Consistent Group

Abstract Background The discrepancy between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in clinical practice may be related to factors such as acute stress, renal dysfunction, and anemia, and its relationship with in-hospital outcomes is uncertain. The aim of this study is to investigate the association between the type of discrepancy between HbA1c and FPG and in-hospital outcomes in patients with acute coronary syndrome (ACS) and diabetes. Methods The Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project is a national, hospital-based quality improvement project with an ongoing database. Patients with ACS, diabetes and complete HbA1c and FPG values at admission were included. The consistent group included patients with HbA1c < 6.5% and FPG < 7.0 mmol/L or HbA1c ≥ 6.5% and FPG ≥ 7.0 mmol/L. The discrepancy group included patients with HbA1c ≥ 6.5% and FPG < 7.0 mmol/L (increased HbA1c group) or HbA1c < 6.5% and FPG ≥ 7.0 mmol/L (increased FBG group).Results A total of 7,762 patients were included in this study. The numbers of patients in the consistent group and discrepancy group were 5,490 and 2,272 respectively. In the discrepancy group, increased HbA1c accounted for 77.5% of discrepancies, and increased FPG accounted for 22.5% of discrepancies. After adjusting for confounders, patients in the increased FPG group had a 1.6-fold increased risk of heart failure (OR, 1.62; 95% CI, 1.08-2.44), a 1.6-fold increased risk of composite cardiovascular death and heart failure (OR, 1.63; 95% CI, 1.09-2.43), and a 1.6-fold increased risk of composite major adverse cardiovascular and cerebrovascular events (MACCEs) and heart failure (OR, 1.56; 95% CI, 1.08-2.24).Conclusions Patients with an increased FPG but normal HbA1c had a higher risk of in-hospital adverse outcomes than those with increased HbA1c but normal FPG. This result may indicate that when HbA1c and FPG are inconsistent in patients with ACS and diabetes, the increased FPG that may be caused by stress hyperglycemia may have a more substantial adverse effect than increased HbA1c, which may be caused by chronic hyperglycemia. These high-risk patients should be given more attention and closer monitoring in clinical practice.Trial registry: Clinicaltrial.gov, NCT02306616. Registered 29 November 2014, https://clinicaltrials.gov/ct2/show/NCT02306616?term=NCT02306616&draw=2&rank=1

scholarly journals Type of discrepancy between glycosylated hemoglobin and fasting plasma glucose is associated with in-hospital outcomes in patients with acute coronary syndrome and diabetes: findings from the Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) Project

2020 ◽  
Author(s):  
Nan Ye ◽  
Lijiao Yang ◽  
Guoqin Wang ◽  
Weijing Bian ◽  
Fengbo Xu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Coronary Syndrome ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Glycosylated Hemoglobin ◽  
Hospital Outcomes ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Consistent Group

Abstract Background The aim of this study is to investigate the association between types of discrepancy between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) and in-hospital outcomes in patients with acute coronary syndrome (ACS) and diabetes, based on Improving Care for Cardiovascular Disease in China - acute coronary syndrome project. MethodsCCC-ACS project is a national, hospital-based quality improvement project. Patients with ACS, diabetes and complete HbA1c and FBG value at admission were included in this study. Patients were divided into consistent group and discrepancy group based on the HbA1c and FBG value at admission. Consistent group included patients with HbA1c < 6.5% and FBG < 7.0 mmol/L, or patients with HbA1c ≥ 6.5% and FBG ≥ 7.0 mmol/L. Discrepancy group included patients with HbA1c ≥ 6.5% and FBG < 7.0 mmol/L, or patients with HbA1c < 6.5% and FBG ≥ 7.0 mmol/L. Discrepancy group was further divided into increased HbA1c group (HbA1c ≥ 6.5% and FBG < 7.0 mmol/L) and increased FBG group (HbA1c < 6.5% and FBG ≥ 7.0 mmol/L).ResultsA total of 7,762 patients were included in this study. Patients in consistent group and discrepancy group were 5,490 (70.7%) and 2,272 (29.3%) respectively. In discrepancy group, increased HbA1c group accounted for 77.5% (1,761/2,272), and increased FPG group accounted for 22.5% (511/2,272). After adjusting for confounders by multivariate logistic regression model, patients in increased FPG group had a significantly 1.6-fold increased risk of heart failure (OR, 1.62; 95% CI, 1.08-2.44), a 1.6-fold increased risk of composite of cardiovascular death and heart failure (OR, 1.63; 95% CI, 1.09-2.43), and a 1.6-fold increased risk of composite of MACCE and heart failure (OR, 1.56; 95% CI, 1.08-2.24).Conclusions Patients with an increased level of FPG but normal HbA1c had a higher risk of in-hospital cardiovascular adverse outcomes than those with an increased level of HbA1c but normal FPG. These patients should be given more attention and closer monitoring in clinical practice in order to improve the in-hospital outcomes.

scholarly journals Comparison of Diagnostic Criteria to Detect Undiagnosed Diabetes in Acute Coronary Syndrome Patients with Admission Hyperglycemia

2015 ◽  
Vol 8 (1) ◽  
pp. 35-42
Author(s):  
Mohammad Sarwar Alam ◽  
HI Lutfur Rahman Khan ◽  
Abdul Wadud Chowdhury ◽  
Khandker Md Nurus Sabah ◽  
Md Gaffar Amin ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Oral Glucose Tolerance Test ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Tolerance Test ◽  
Undiagnosed Diabetes ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Coronary Syndrome ◽  
Fasting Plasma

Background: Diabetes mellitus is one of the most important risk factors of coronary artery disease. Admission hyperglycemia adversely influences the outcome of acute coronary syndrome patients. The study was conducted to compare the various diagnostic methods for the detection of undiagnosed diabetes mellitus in acute coronary syndrome patients with admission hyperglycaemia in Bangladeshi population.Methods: It was a cross sectional comparative study involving 157 patients with admission blood glucose level e”7.8 mmol/l. Fasting plasma glucose, Glycated haemoglobin, pre-discharge oral glucose tolerance test was measured in all subjects and comparison of performance of different methods was done.Results: Oral glucose tolerance test revealed that in spite of admission hyperglycaemia, 57 (36.3%) patients were diabetic and 52 (33.12%) patients had impaired glucose homeostasis and 48 (30.57%) patients had normal glucose metabolism. Undiagnosed diabetes could not be adequately predicted with admission plasma glucose, fasting plasma glucose or HbA1c alone (area under the ROC curve 0.589, 0.825 and 0.852 respectively).Conclusion: Admission hyperglycaemia does not diagnose diabetes reliably in a stressful condition like acute coronary syndrome. Although neither admission plasma glucose, fasting plasma glucose, nor HbA1c level were as good as oral glucose tolerance test in detecting true diabetes, but combined fasting plasma glucose & HbA1c were found to be more sensitive & specific screening tool for detecting unknown diabetes in acute coronary syndrome patients with admission hyperglycaemia.Cardiovasc. j. 2015; 8(1): 35-42

scholarly journals Impact of low fasting plasma glucose on mortality in the general population

2020 ◽  
Vol 17 (3) ◽  
pp. 147916412093059
Author(s):  
Parag A Chevli ◽  
Muhammad Imtiaz Ahmad ◽  
Krupal Hari ◽  
Muhammad Ali Anees ◽  
Elsayed Z Soliman
Keyword(s):  
Cardiovascular Disease ◽  
Confidence Interval ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Hazard Ratio ◽  
Fasting Plasma ◽  
Increased Risk ◽  
All Cause Mortality

Background: While the association between hypoglycaemia and poor outcomes in diabetes is well established, it is unclear whether such an association is generalizable to those without diabetes. Methods: A total of 8497 participants free of cardiovascular disease and diabetes from the Third National Health and Nutrition Examination Survey were included. We examined the relationship between baseline low (<80 mg/dL) and high (⩾126 mg/dL) fasting plasma glucose compared to normal levels (80–99 mg/dL). Results: Over a median follow-up of 14 years, 2101 deaths occurred, of which 570 were due to cardiovascular disease. In a model adjusted for sociodemographic and cardiovascular disease risk factors, individuals with low fasting plasma glucose were at increased risk of cardiovascular disease and all-cause mortality [hazard ratio = 1.79 (95% confidence interval = 1.04–3.08) and hazard ratio = 1.35 (95% confidence interval = 1.02–1.78), respectively], compared to those with normal fasting plasma glucose. These associations were stronger among men than women for both cardiovascular disease mortality and all-cause mortality. Conclusion: Low fasting plasma glucose in individuals without diabetes is a risk factor for cardiovascular disease and all-cause mortality, especially in men.

scholarly journals Assessment of Cardiovascular Disease Risk in Prediabetes

2020 ◽  
pp. 1-8
Author(s):  
Ashish Agarwal ◽  
Anupama Hegde ◽  
Afzal Ahmad ◽  
Charu Yadav ◽  
Poornima A. Manjrekar ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Interleukin 6 ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Anthropometric Measurements ◽  
Waist To Hip Ratio ◽  
Fasting Plasma ◽  
Increased Risk

Introduction: Prediabetes is associated with dysglycemia, endothelial dysfunction, obesity and inflammation, placing them at an increased risk of cardiovascular events. Aims: The present study aimed to investigate the risk of cardiovascular disease associated with prediabetes by estimation of serum interleukin-6, myeloperoxidase and urine microalbumin and their correlation with fasting plasma glucose and anthropometric measurements. Study Design: Cross sectional study. Place and Duration of Study: Study was conducted at Department of Biochemistry, Kasturba Medical College Hospitals, Mangaluru between 2014 and 2015. Methodology: Eighty subjects were categorised into prediabetes and healthy controls based on their fasting plasma glucose values. Anthropometric data (weight, body mass index, waist circumference, hip circumference and waist-to-hip ratio from all subjects were recorded. Interleukin-6 & myeloperoxidase were estimated in serum sample whereas microalbumin was estimated in random urine sample. Results: The mean anthropometric measurements and cardiovascular disease risk markers (interleukin-6, myeloperoxidase and urine microalbumin) were found to be significantly higher (p < 0.05) in prediabetes group. Myeloperoxidase had significant correlation with fasting plasma glucose (r-0.388) in the prediabetes group. Interleukin-6 and myeloperoxidase also showed a positive correlation with body mass index (r - 0.339, r - 0.327), waist circumference (r - 484, r - 0.493) and waist-to-hip ratio (r - 0.430, r - 0.493) while urine microalbumin did not correlate with fasting plasma glucose and anthropometric measurements in prediabetes group. Conclusion: This study suggests that prediabetes is associated with central adiposity and have an increased risk for cardiovascular disease.

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