Long-term Outcome in Patients With ACS and Dysglycaemia
Long-term Outcome in Patients With ACS and Dysglycaemia
There is a global increase in the prevalence of type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT), which are major risk factors for atherosclerosis including acute coronary syndrome (ACS) caused by coronary artery disease (CAD). T2DM and IGT have been shown to occur among as many as two-thirds of patients with ACS and previously unknown diabetes. A long-term follow-up of these patients has demonstrated that these newly detected glucose disturbances also affect future prognosis.
The Euro Heart Survey shows that a majority of patients diagnosed with CAD including ACS have abnormal glucose regulation, and two earlier studies that included previously healthy individuals showed that IGT leads to an increased risk of cardiovascular disease (CVD) and death. There are several factors contributing to why patients with T2DM and IGT are particularly prone to develop ACS. Among these are vascular endothelial dysfunction, disturbed platelet function, decreased fibrinolytic capacity, high levels of advanced glycation end products (AGEs), dyslipidemia, hypertension and reduced insulin sensitivity.
T2DM develops slowly through stages of early impairments of glucose metabolism. A majority of subjects who develop T2DM demonstrate IGT approximately 5 years prior to diagnosis. With regard to ACS, the research to date has tended to focus on diabetes rather than IGT. Thus, the impact of IGT on ACS, and cardiovascular morbidity and mortality in general, is yet to be revealed. A large study of patients with CAD showed that diabetes, whether it is previously known or newly detected, is an independent risk factor for mortality and myocardial infarction during a 1-year follow-up period. Impaired glucose regulation, including IGT and impaired fasting glucose (IFG), was not an independent predictor of adverse outcomes in these patients. However, over a longer period of time, glucose levels far below the threshold for diabetes have been shown to markedly increase the risk of cardiovascular events.
The primary aim of the present study was to investigate the importance of dysglycaemia detected by an oral glucose tolerance test (OGTT) for long-term mortality and cardiovascular events in patients with ACS.
Background
There is a global increase in the prevalence of type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT), which are major risk factors for atherosclerosis including acute coronary syndrome (ACS) caused by coronary artery disease (CAD). T2DM and IGT have been shown to occur among as many as two-thirds of patients with ACS and previously unknown diabetes. A long-term follow-up of these patients has demonstrated that these newly detected glucose disturbances also affect future prognosis.
The Euro Heart Survey shows that a majority of patients diagnosed with CAD including ACS have abnormal glucose regulation, and two earlier studies that included previously healthy individuals showed that IGT leads to an increased risk of cardiovascular disease (CVD) and death. There are several factors contributing to why patients with T2DM and IGT are particularly prone to develop ACS. Among these are vascular endothelial dysfunction, disturbed platelet function, decreased fibrinolytic capacity, high levels of advanced glycation end products (AGEs), dyslipidemia, hypertension and reduced insulin sensitivity.
T2DM develops slowly through stages of early impairments of glucose metabolism. A majority of subjects who develop T2DM demonstrate IGT approximately 5 years prior to diagnosis. With regard to ACS, the research to date has tended to focus on diabetes rather than IGT. Thus, the impact of IGT on ACS, and cardiovascular morbidity and mortality in general, is yet to be revealed. A large study of patients with CAD showed that diabetes, whether it is previously known or newly detected, is an independent risk factor for mortality and myocardial infarction during a 1-year follow-up period. Impaired glucose regulation, including IGT and impaired fasting glucose (IFG), was not an independent predictor of adverse outcomes in these patients. However, over a longer period of time, glucose levels far below the threshold for diabetes have been shown to markedly increase the risk of cardiovascular events.
The primary aim of the present study was to investigate the importance of dysglycaemia detected by an oral glucose tolerance test (OGTT) for long-term mortality and cardiovascular events in patients with ACS.
