Background:
Fluctuations in glucose levels give rise to inflammation and endothelial dysfunction by increasing oxidative stress. Mean amplitude of glycemic excursions (MAGE) is commonly used as a degree of fluctuations in glucose levels, and plays a significant role in vascular endothelial dysfunction in patient with diabetes mellitus (DM). Vascular endothelial dysfunction is associated with cardiovascular event risk. Thus, we examined the impact of MAGE on vascular endothelial dysfunction and clinical outcomes in non DM patients with CAD.
Methods:
We analyzed 22 non DM patients with CAD following percutaneous coronary intervention (PCI) during 12 months follow up, and assessed the relationship among MAGE, the level of high-sensitivity CRP (hs-CRP), and reactive hyperemia index (RHI) measured from RH-PAT (reactive hyperemia peripheral arterial tonometry). Cardiovascular events were cardiovascular death, myocardial infarction, stroke, unstable angina,and revascularization.
Results:
In clinical characteristics of total patients, age, HbA1c, average of blood glucose for 24 hour, and MAGE were 73ys, 5.93%, 121.5mg/dl, and 55.5mg/dl. MAGE correlated with hs-CRP (r=0.610; P=0.004) and RHI (r=–0.485; P=0.047), but not correlated with HbA1c, LDL cholesterol, HDL cholesterol, triglyceride, and systolic blood pressures. In short, high glycemic excursions (high MAGE) is associated with high inflammation (high hs-CRP) and vascular endothelial dysfunction (low RHI). When patients were classified into MAGE<60mg/dl (normal glycemic excursions) and MAGE>60mg/dl (high glycemic excursions), group of MAGE>60mg/dl were significant higher in hs-CRP (0.251±0.301 vs 0.072±0.067mg/dl, P=0.048) and lower in RHI (0.392±0.193 vs 0.834±0.316, P=0.008) than group of MAGE<60mg/dl. Multivariate analysis for vascular endothelial dysfunction identified MAGE as a predictive factor (OR13.3, 95%RI 1.069-166.4, P=0.044). Moreover, MAGE was an independent predictive factor for cardiovascular events (OR11.0, 95%RI 1.42-85.20, P=0.022)
Conclusions:
Fluctuations in glucose levels are associated with inflammation, endothelial dysfunction, and cardiovascular events risk in non DM patients with CAD.
Association between glycemic control and morning blood surge with vascular endothelial dysfunction in type 2 diabetes mellitus patients
