Impact of prediabetes on cardiovascular disease risk in patients with acute myocardial infarctions

Öz

Aim: Prediabetes is known to be associated with increased cardiovascular diseases (CVD) risk and mortality. It has been reported that more than 70% of pre-diabetic patients develop Diabetes Mellitus (DM). In patients with acute myocardial infarction (AMI), diabetes increases a 2 to 4 fold risk of adverse cardiovascular events compared to non-diabetic patients. This morbidity-mortality relationship begins in the progression phase from normal glucose tolerance to diabetes. We evaluated the relationship between the presence of pre-diabetes by using hemoglobin A1c (HbA1c) values and CVD risk in patients presenting with newly diagnosed AMI. Methods: This study was a retrospective, single-centre and we examined consecutive patients who underwent coronary angiography with a diagnosis of AMI at our hospital between March 2019 and September 2020. A total of 332 patients with AMI were enrolled; patients were divided into two groups according to their HbA1c levels: non-diabetic group (HbA1c <5.7%) and pre-diabetic group (5.7% ≤HbA1c <6.05%). The primary composite endpoints were cardiovascular death, myocardial infarction or stroke. Results: Of the 332 patients, 204 (61%) patients had non-diabetic groups, and 128 (39%) patients were between the pre-diabetic groups. During the follow-up period, the primary composite endpoints amounted to 7.4% and 15.6% in the non-diabetes and prediabetes group (p=0.026). The incidences of cardiovascular death and myocardial infarction were significantly higher in the prediabetic group than the nondiabetic group (p= 0.021, p=0.004; respectively). Independent predictors for the primary composite endpoints following the multivariate analysis included SYNTAX score (odds ratio [OR]: 0.912; %95 confidence interval [CI]: 0.832- 0.999, p: 0.047), left ventricular ejection fraction (OR: 0.812; %95 CI: 0.753- 0.876, p< 0.001), systolic blood pressure (OR: 0.955; %95 CI: 0.927- 0.985, p: 0.003) and valuable categorical HbA1c (5.7% ≤HbA1c<6. 5%) (OR: 2.787; %95 CI: 1.091- 7.120, p: 0.032). Conclusion: Prediabetes group has been shown to have a higher incidence of the primary composite endpoints than non-diabetes. SYNTAX score, left ventricular ejection fraction, systolic blood pressure, and HbA1c (categorical variable) were found as independent predictors for the primary composite endpoint. Preventive measures in the stage of pre-diabetes might help the prevention of developing CVD.

Anahtar Kelimeler

• Cardiovascular Diseases
• Myocardial infarction
• Prediabetic State

Akut miyokard enfarktüslü hastalarda prediyabetin kardiyovasküler hastalık riskine etkisi

Öz

Amaç: Prediyabetin artmış kardiyovasküler hastalıklar (KVH) riski ve mortalite ile ilişkili olduğu bilinmektedir. Prediyabetik hastaların %70'inden fazlasında Diabetes Mellitus (DM) geliştiği bildirilmiştir. Akut miyokard enfarktüsü (AME) olan hastalarda diyabet, diyabetik olmayan hastalara kıyasla istenmeyen kardiyovasküler olay riskini 2-4 kat artırır. Bu morbidite-mortalite ilişkisi normal glukoz toleransından diyabete ilerleme aşamasında başlar. Yeni tanı almış AME ile başvuran hastalarda, hemoglobin A1c (HbA1c) değerleri kullanılarak prediyabet varlığı ile KVH riski arasındaki ilişkiyi değerlendirdik. Yöntemler: Bu çalışma retrospektif, tek merkezli olup, Mart 2019-Eylül 2020 tarihleri arasında ardışık olarak, hastanemizde AME tanısı ile koroner anjiyografi yapılan hastalar incelendi. Toplam 332 AME hastası kaydedildi; hastalar HbA1c düzeylerine göre 2 gruba ayrıldı: diyabetik olmayan grup (HbA1c <%5,7, n = 204) ve prediyabetik grup (%5,7 ≤HbA1c <%6,5, n = 128). Birincil bileşik son noktalar, kardiyovasküler ölüm, miyokardiyal enfarktüs ve inme olarak belirlendi. Bulgular: 332 hastanın 204'ü (%61) diyabetik olmayan gruba, 128 (%39) hasta prediyabetik grup arasındaydı. Takip süresi boyunca, birincil birleşik sonlanım noktaları diyabet olmayan ve prediyabet grubunda %7,4 ve %15,6 olarak bulundu (p = 0,026). Prediyabetik grupta kardiyovasküler ölüm ve miyokard infarktüsü insidansı, diyabetik olmayan gruba göre anlamlı olarak daha yüksekti (sırasıyla p = 0,021, p = 0,004). Çok değişkenli analizi takiben birincil birleşik sonlanım noktaları için bağımsız öngörücüler arasında SYNTAX skoru (OR: 0,912; %95 GA: 0,832- 0,999, p: 0,047) , sol ventriküler ejeksiyon fraksiyonu (OR: 0,812; %95 GA: 0,753- 0,876, p< 0,001), sistolik kan basıncı (OR: 0,955; %95 GA: 0,927- 0,985, p: 0,003) ve kategorik değerli HbA1c (%5,7 ≤HbA1c<%6,5) (OR: 2,787; %95 GA: 1,091- 7,120, p: 0,032) yer aldı. Sonuç: Prediyabet grubunun diyabet olmayanlara kıyasla birincil bileşik sonlanım noktalarının daha yüksek insidansına sahip olduğu gösterilmiştir. Bileşik sonlanım noktası için bağımsız öngörücü olarak SYNTAX skoru, sol ventriküler ejeksiyon fraksiyonu, sistolik kan basıncı ve HbA1c (kategorik değişken) bulundu. Prediyabet aşamasında önleyici tedbirler, KVH gelişiminin önlenmesine yardımcı olabilir.

Anahtar Kelimeler

• Kardiyovasküler Hastalıklar
• Miyokard enfarktüsü
• Prediyabetik Durum

Kaynakça

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