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Cumulative frequency of fasting and 2 h blood glucose values for patients with and without coronary heart disease. Cumulative frequencies of patients with and without coronary heart disease (CHD) were plotted against blood glucose values in (A) fasting state and (B) 2 h after an oral glucose tolerance test. Blood glucose ranges were divided into sextiles with the lowest sextile defined as reference group each. Shown are the numbers and percentages of patients as well as the odds ratios for CHD in the respective blood glucose sextiles.

Cumulative frequency of fasting and 2 h blood glucose values for patients with and without coronary heart disease. Cumulative frequencies of patients with and without coronary heart disease (CHD) were plotted against blood glucose values in (A) fasting state and (B) 2 h after an oral glucose tolerance test. Blood glucose ranges were divided into sextiles with the lowest sextile defined as reference group each. Shown are the numbers and percentages of patients as well as the odds ratios for CHD in the respective blood glucose sextiles.

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Diabetes mellitus type 2 (DM2) is a risk factor for coronary heart disease (CHD). While there is a clear correlation of fasting blood glucose (FBG) and 2 h post-challenge blood glucose values (2h-BG) with microvascular complications, the risk for CHD conferred by glucose dysregulation antecedent to DM2 is less clear. Therefore, we investigated asso...

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... Simil arly, Gui et al. studied 906 non-T2DM patients undergoing CAG and found FPG to be an independent risk factor for severity of CAD according to the GENSINI score [26]. Schinner et al. and Qian et al. also reported FPG to be independently correlated with the burden of atherosclerosis [27,28]. 409 patients from China were studied in another study which also inferred that the coronary artery stenosis score increased with rising FPG [29]. ...
Article
Aim The objective was to assess the correlation of fasting plasma glucose (FPG), HbA1c, and the duration of type 2 diabetes mellitus (T2DM) with SYNTAX score (SS) II in patients with non-ST elevation myocardial infarction (NSTEMI). Material and methods FPG and HbA1C were measured in 398 patients presenting with NSTEMI at admission. SS II was calculated using an online calculator. Patients were stratified according to SS II (≤21.5, 21.5–30.6, and ≥30.6), defined as SS II low, mid, and high, respectively. Results 37.7 % of subjects were diabetic. Correlations of FPG (R=0.402, R2=0.162, p<0.001) and HbA1c (R=0.359, R2=0.129, p<0.001) with SS II were weak in the overall population. Duration of T2DM showed very strong correlation with SS II (R=0.827, R2=0.347). For the prediction of high SS II in the study population, FPG≥98.5 mg / dl demonstrated a sensitivity of 58 % and a specificity of 60 %, and HbA1c ≥6.05 demonstrated a sensitivity of 63 % and a specificity of 69 %. Duration of T2DM (adjusted odds ratio (OR): 1.182; 95 % confidence interval (CI): 1.185–2.773) and FPG (OR: 0.987; 95 % CI: 0.976–0.9959) were significantly associated with high SS II after controlling for other risk factors. Duration of T2DM (Beta=0.439) contributed strongly to variance of SS II, whereas HbA1c (Beta=0.063) contributed weakly. Conclusion Duration of T2DM is a very important risk factor for severity of coronary artery disease.
... Elevated FBG levels are often related to IR and trigger oxidative stress, protein C kinase activation and non enzymatic protein glycosylation, resulting in acceleration of atherosclerosis by impairment of endothelial cell function, the decrease of NO release and inducing of procoagulant [20,21]. Several studies have demonstrated that increased FBG may lead to an increase risk of cardiovascular risk factors and CAD [22,23]. As in CAD, hyperglycemia may be responsible for CSF pathogenesis due to its adverse effects on endothelial function. ...
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Aim: This study aimed to evaluate the relationship between coronary slow flow (CSF) with fasting blood glucose/high-density lipoprotein cholesterol ratio (GHR) and monocyte/high-density lipoprotein cholesterol ratio (MHR) in patients without overt diabetes and to reveal the effects of hyperglycemia and inflammation on CSF development. Material and Methods: In this retrospective study, a total of 237 patients who underwent coronary angiography were enrolled and divided into two groups according to CSF presence. 109 of them had CSF and 128 of them had normal coronary flow (CNF). The thrombolysis in myocardial infarction (TIMI) frame count (TFC) was calculated for each coronary artery and the values above the normal range was defined as CSF. Results: GHR and MHR were significantly higher in CSF patients compared to those without (p<0.001, p<0.001). In correlation analysis, total TFC showed a statistically significant relation with these markers (for both r=0.745, p<0.001). In multivariate logistic regression analysis, GHR and MHR were independent predictors for CSF presence (p<0.001, p<0.001). The receiver operating characteristic (ROC) curve analysis showed the best cut off values of GHR and MHR as 2.105 and as 12.93, respectively (AUC=0.861, p<0.001; AUC=0.849, p<0.001). Conclusion: In this study, there was a strong relationship between CSF with GHR and MHR. In addition, elevated values of GHR and MHR supported the roles of hyperglycemia and inflammation in CSF etiopathogenesis.
... DM increases morbidity and mortality by facilitating atherosclerosis with several mechanisms. 1 The patients with impaired glucose tolerance (IGT) are accepted as prediabetic patients, and it was established that the risk of coronary artery disease (CAD) is increased in these patients with coronary angiography. 2,3,4 The first finding of CAD is macrovascular obstruction, and this can not be demonstrated with coronary angiography. The microvascular obstruction could be evaluated by cardiac magnetic resonance (MR) imaging with the "first pass" perfusion technique, and as we know, there is no published paper about the evaluation of microvascular obstruction in patients with IGT. ...
Article
Objectives: Myocardial blood flow was evaluated with magnetic resonance (MR) perfusion in the patients with impaired glucose tolerance (IGT), and the existence of microvascular obstruction and risk for cardiac diseases were researched. In addition, the wall motion, wall mass (gram), and viability of the left ventricle, and the systolic function of both ventricles were evaluated. Materials and Methods: Twenty patients with IGT, 16 patients with type 2 diabetes mellitus (DM) and 15 patients with normal MR findings were included in our study. All patients were examined in the supine position using a body coil with 1.5 Tesla MR. Firstly, images B-TFE cine sequences to see the wall motions, calculate the wall mass and the left ventricular ejection fraction. "Black blood" T2-weighted and STIR sequences were then taken to exclude other cardiac myocardial diseases. Basal, midventricular, and apical short-axis sequences were obtained by intravenous administration of 0.2 mmol/kg Gd-DTPA to evaluate first-pass perfusion. And late opacification findings were obtained 10 minutes after the injection with the "inversion recovery GRE" sequence. Results: When peak enhancement and accumulated enhancement in the first pass perfusion of myocardial tissue were investigated, the similarity was found in cases with IGT and type-2 DM. However, significant differences were found compared to the healthy control group. In the first pass perfusion; When contrast agent arrival time and the peak of contrast agent increase in myocardial tissue were compared, no difference was observed between these groups. In addition, left and right ventricular systolic functions were similar between groups. Conclusion: In the cases with IGT, myocardial microvascular circulation disorders can emerge in early phases without the presence of coronary artery disease. In these kinds of cases, cardiac MRI can be an important choice.
... (Li et al. 2012). However, coincident with the previous reports (Bartnik et al. 2004;Muntner et al. 2004;Oliveira et al. 2007;Schinner et al. 2011), we found that the Gensini scores were increased along with the elevation of FPG levels regardless of the race. We also found that the levels of FPG were positively correlated to the Gensini scores, and was an independent risk factor of CAD, which indicated that more severe impaired fasting glucose would result in more serious CAD. ...
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The aim of the study is to investigate the association of fasting plasma glucose (FPG) with the prevalence and severity of coronary artery disease (CAD) in different ethnic groups without diabetes history in Xinjiang. Patients without diabetes history, who had undergone coronary angiography, were obtained. The levels of FPG in different ethnics were analyzed. The Gensini score was explored to evaluate the degree of coronary artery stenosis, and the logistic regression analysis was adopted to explore the risk factors of the prevalence of CAD. A total of 1500 cases (men 71.2%; mean age 57.6 ± 10.6 years; 1095 cases of CAD) were included. The incidence rates of CAD were 76.8% in Han, 72.5% in Uyghur and 68.1% in Kazakh group, respectively (P = .009), while the Gensini scores in Kazahk group (36.63 ± 33.88) were lower than the other ethnic populations (P = .003). The FPG levels in patients with CAD were significant higher than that without in all the ethnic groups (P < .01). Furthermore, it was indicated that the FPG levels (OR = 1.22, 95%CI 1.07–1.39, P = .003), as well as the age, sex, smoking or hypertension history, were associated with the CAD risk. FPG level was an independent risk factor of the prevalence and severity of CAD in population in Xinjiang.
... Recently, diabetes has been noted as a new independent risk factor of coronary heart disease [22]. Many researchers have demonstrated that diabetes is an independent risk factor for the prevalence and severity of significant angiographic CAD [23][24][25]. Research in Chinese populations has also demonstrated that GS correspondingly increased with FPG (fasting blood glucose) levels [23]. Our stepwise multiple linear regression analysis showed that the diabetes prevalence rate in these subgroups are significantly different, and the diabetes 1756 prevalence rate was significantly higher in patients with GS >45 compared with patients with scores of [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] or £26. ...
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Background The role of pigment epithelium-derived factor (PEDF) in protection of coronary artery disease (CAD) remains controversial. The aim of this study was to reassess the value of PEDF in predicting the severity and prognosis of newly diagnosed stable CAD in a Chinese population. Material/Methods Plasma PEDF levels were measured in 259 stable CAD patients undergoing coronary angiography and 116 age- and sex-matched healthy controls. The severity of coronary atherosclerosis was assessed using Gensini score. Results PEDF levels were significantly lower in CAD patients than in healthy subjects (5.856±0.790 vs. 6.658±1.070 μg/ml, respectively, p<0.01). Stepwise regression analysis showed a negative correlation between PEDF levels and severity of CAD as quantified by Gensini score value (β=−0.626, p<0.01). Conclusions Our study showed that plasma PEDF levels were significantly lower in CAD patients than in controls, and the plasma PEDF levels may be used as a potential predicator for coronary severity.
... (Did those patients have the same risk profile or may have higher risk profile compared to the other group??) (they may be more dyslipidemic, older in age or other risk factors may be higher in score in those prediabetics in their study??) It was approved that many individuals with prediabetes, which refers to impaired fasting glucose, impaired glucose tolerance or both, already display micro vascular disease consequences similar to those seen in patients with T2DM (22) . However, it is not established whether prediabetes should be considered a coronary heart disease risk equivalent (22) , and there are controversial data concerning the correlation between a blood glucose level in the sub diabetic range (impaired fasting glucose and impaired glucose tolerance) and cardiovascular risks (23) . Most of Studies discussed the relation between IGR and severity of CAD assessed by coronary angiography included stable chronic patients and used OGTT or FPG alone to detect prediabetic stage, while we used FPG and/or HbA1c in patients with ACS. ...
... 147,148 However, because current diagnostic criteria are based on microvascular end points, macrovascular insults often present well before glucose level elevates to diabetic range. 149 Because plasma glucose concentration distributes over a continuum, it would not be surprising that both prediabetic and diabetic patients are at increased risk of CV disease. 147,148 Aggressive management for lipid disorder and other risk factors has been proven to reduce macrovascular complications in these patients. ...
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In Taiwan, the prevalence of hyperlipidemia increased due to lifestyle and dietary habit changes. Low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) are all significant predicting factors of coronary artery disease in Taiwan. We recognized that lipid control is especially important in patients with existed atherosclerotic cardiovascular diseases (ASCVD), including coronary artery disease (CAD), ischemic stroke and peripheral arterial disease (PAD). Because the risk of ASCVD is high in patients with diabetes mellitus (DM), chronic kidney disease (CKD) and familial hypercholesterolemia (FH), lipid control is also necessary in these patients. Lifestyle modification is the first step to control lipid. Weight reduction, regular physical exercise and limitation of alcohol intake all reduce triglyceride (TG) levels. Lipid-lowering drugs include HMG-CoA reductase inhibitors (statins), cholesterol absorption inhibitors (ezetimibe), proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, nicotinic acids (niacin), fibric acids derivatives (fibrates), and long-chain omega-3 fatty acids. Statin is usually the first line therapy. Combination therapy with statin and other lipid-lowering agents may be considered in some clinical settings. For patients with acute coronary syndrome (ACS) and stable CAD, LDL-C < 70 mg/dL is the major target. A lower target of LDL-C <55 mg/dL can be considered in ACS patients with DM. After treating LDL-C to target, non-HDL-C can be considered as a secondary target for patients with TG ≥ 200 mg/dL. The suggested non-HDL-C target is < 100 mg/dL in ACS and CAD patients. For patients with ischemic stroke or transient ischemic attack presumed to be of atherosclerotic origin, statin therapy is beneficial and LDL-C < 100 mg/dL is the suggested target. For patients with symptomatic carotid stenosis or intracranial arterial stenosis, in addition to antiplatelets and blood pressure control, LDL-C should be lowered to < 100 mg/dL. Statin is necessary for DM patients with CV disease and the LDL-C target is < 70 mg/dL. For diabetic patients who are ≥ 40 years of age, or who are < 40 years of age but have additional CV risk factors, the LDL-C target should be < 100 mg/dL. After achieving LDL-C target, combination of other lipid-lowering agents with statin is reasonable to attain TG < 150 mg/dL and HDL-C >40 in men and >50 mg/dL in women in DM. LDL-C increased CV risk in patients with CKD. In adults with glomerular filtration rate (GFR) < 60 mL/min/1.73m² without chronic dialysis (CKD stage 3–5), statin therapy should be initiated if LDL-C ≥ 100 mg/dL. Ezetimibe can be added to statin to consolidate the CV protection in CKD patients. Mutations in LDL receptor, apolipoprotein B and PCSK9 genes are the common causes of FH. Diagnosis of FH usually depends on family history, clinical history of premature CAD, physical findings of xanthoma or corneal arcus and high levels of LDL-C. In addition to conventional lipid lowering therapies, adjunctive treatment with mipomersen, lomitapide, or PCSK9 inhibitors become necessary to further reduce LDL-C in patients with FH. Overall, these recommendations are to help the health care professionals in Taiwan to treat hyperlipidemia with current scientific evidences. We hope the prescription rate of lipid lowering drugs and control rate of hyperlipidemia in high risk patients could be increased by implementation of the clinical guidelines. The major purpose is to improve clinical outcomes of these high risk patients through the control of hyperlipidemia.
... Many individuals with prediabetes, which refers to impaired fasting glucose, impaired glucose tolerance or both, already display microvascular disease consequences similar to those seen in patients with T2DM (3). However, it is not established whether prediabe-tes should be considered a coronary heart disease risk equivalent (3), and there are controversial data concerning the correlation between a blood glucose level in the subdiabetic range (impaired fasting glucose and impaired glucose tolerance) and cardiovascular risks (4). Several studies have shown that the fasting plasma glucose (FPG) level is related to the severity and extent of coronary artery lesions (5)(6)(7). ...
Article
Objective: This study was designed to determine the SYNTAX score under different fasting plasma glucose (FPG) states in Chinese patients undergoing coronary angiography, particularly subjects with impaired FPG. Methods: Four hundred and forty-six subjects undergoing coronary angiography were enrolled in this study and divided into four groups based on the FPG level or a history of type 2 diabetes mellitus (T2DM): normal FPG, impaired FPG, known and previously unknown T2DM. Results: The angiographic SYNTAX scores were higher in the subjects with known (p<0.001) or previously unknown (p<0.001) T2DM than in those with normal FPG. There were significant differences in the number of diseased coronary artery vessels between the subjects with known (p<0.01) or unknown T2DM (p<0.05) and the subjects with normal FPG. However, there were no significant differences in the SYNTAX score or the number of diseased coronary artery vessels between the subjects with impaired FPG and those with normal FPG. The subjects with impaired FPG (2.917-fold, p=0.004) and known (3.064-fold, p=0.000) or previously unknown (3.301-fold, p=0.000) T2DM exhibited a significantly elevated risk of having an intermediate or high SYNTAX score compared with the subjects with normal FPG. Conclusion: Chinese subjects with impaired FPG have a significantly elevated risk of having an intermediate or high SYNTAX score, indicating a risk of severe coronary artery lesions. Subjects with known or previously unknown T2DM may have severe coronary artery lesions. These findings suggest the importance of achieving better glycemic control in order to prevent coronary atherosclerosis and improve the cardiovascular prognosis.
... Of these, 34.3% were classified as PH, which was diagnosed using OGTT; (4) Known DM, PH, LDL-C >100 mg/dl, and previous stroke were independent predictors of MACE in patients with stable angina undergoing PCI. Several studies have reported the impact of different glucose abnormalities on clinical outcomes in patients with cardiovascular disease [16,19202122232425. However, most of the studies were performed on heterogeneous groups of patients, i.e., those with stable and unstable angina, myocardial infarction, or heart failure. ...
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Background Post-challenge hyperglycemia (PH) is well-established as one of risk factors for coronary artery disease. However, it remains unclear whether PH affects clinical outcomes in patients with stable angina undergoing percutaneous coronary intervention (PCI). Methods A total of 828 patients with stable angina undergoing PCI were retrospectively analyzed. Of these, 452 patients with previously diagnosed diabetes mellitus (DM) or fasting plasma glucose (PG) ≥126 mg/dl and HbA1c ≥6.5% were defined as known DM. The remaining 376 patients were divided into the two groups according to 2-h PG: PH (2-h PG ≥140 mg/dl, n=236) and normal glucose tolerance (NGT, 2-h PG <140 mg/dl, n=140). We assessed the rate of major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, and clinically-driven revascularization. Results During the median follow-up of 4.3 years, the MACE rate was significantly higher in the DM and PH groups than the NGT group (39.3% vs. 20.7%, P <0.001; 31.4% vs. 20.7%, P=0.044, respectively). Compared with the NGT group, the cumulative incidence of revascularization was significantly higher in the DM group (35.1% vs. 18.5%, P <0.001) and tended to be higher in the PH group (27.1% vs. 18.5%, P=0.067). In the multivariate analysis, known DM (Hazard ratio [HR]: 2.16, 95% confidence interval (CI): 1.49-3.27, P < 0.001), PH (HR: 1.62, 95% CI: 1.07-2.53, P = 0.023), LDL-C >100 mg/dl (HR: 1.62, 95% CI: 1.26 to 2.10, P < 0.001), and previous stroke (HR: 1.47, 95% CI: 1.03-2.04, P = 0.034) were predictors of MACE. Conclusion PH is associated with future cardiovascular events in patients with stable angina undergoing PCI.
... This study also suggests, in line with previous reports [18,19] that 2-h PG is a better risk predictor of CV events than FPG. Concurring with our study, Schinner et al. [20] found a high prevalence of impaired glucose metabolism in patients with coronary heart disease (CHD) assessed by coronary angiography. They found a continuous increased risk of CHD with blood glucose levels even in the subdiabetic range. ...
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Background and purpose The incidence of cardiovascular events remains high in patients with myocardial infarction (MI) despite advances in current therapies. New and better methods for identifying patients at high risk of recurrent cardiovascular (CV) events are needed. This study aimed to analyze the predictive value of an oral glucose tolerance test (OGTT) in patients with acute myocardial infarction without known diabetes mellitus (DM). Methods The prospective cohort study consisted of 123 men and women aged between 31–80 years who had suffered a previous MI 3–12 months before the examinations. The exclusion criteria were known diabetes mellitus. Patients were followed up over 6.03 ± 1.36 years for CV death, recurrent MI, stroke and unstable angina pectoris. A standard OGTT was performed at baseline. Results 2-h plasma glucose (HR, 1.27, 95% CI, 1.00 to 1.62; P < 0.05) and smoking (HR, 3.56, 95% CI, 1.02 to 12.38; P < 0.05) proved to be independent predictors of CV events in multivariate statistical analysis after adjustments for age, sex, total cholesterol, and other baseline characteristics. Conclusions In this study population, with previous MI and without known DM, 2-h PG and smoking were significant predictors of CV death, recurrent MI, stroke and unstable angina pectoris, independent of baseline characteristics and medical treatment.