The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe - The Euro Heart Survey on diabetes and the heart

Erasmus Universiteit Rotterdam, Rotterdam, South Holland, Netherlands
European Heart Journal (Impact Factor: 15.2). 12/2004; 25(21):1880-90. DOI: 10.1016/j.ehj.2004.07.027
Source: PubMed


The objective behind the Euro Heart Survey on diabetes and the heart was to study the prevalence of abnormal glucose regulation in adult patients with coronary artery disease (CAD).
The survey engaged 110 centres in 25 countries recruiting 4196 patients referred to a cardiologist due to CAD out of whom 2107 were admitted on an acute basis and 2854 had an elective consultation. Patient data were collected via a web-based case record form. An oral glucose tolerance test (OGTT) was used for the characterisation of the glucose metabolism. Thirty-one per cent of the patients had diabetes. An OGTT was performed on the 1920 patients without known diabetes, of whom 923 had acute and 997 had a stable manifestation of CAD, respectively. In patients with acute CAD, 36% had impaired glucose regulation and 22% newly detected diabetes. In the stable group these proportions were 37% and 14%.
This survey demonstrates that normal glucose regulation is less common than abnormal glucose regulation in patients with CAD. OGTT easily discloses the glucometabolic state and should be a routine procedure. The knowledge of glucometabolic state among these patients should influence their future management because it has great potential to improve the outcome.

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    • "Hao et al. [12] recently reported that fasting FGF-19 levels were inversely associated with coronary artery disease (CAD). Undiagnosed AGR, especially hyperglycemia after OGL, is common in patients with CAD [13] [14] [15] [16], but the association between FGF-19 increment after OGL and AGR has not been addressed in patients with CAD. "
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    ABSTRACT: Background: We investigated factors associated with fibroblast growth factor 19 (FGF-19) increment after oral glucose loading (OGL) in human subjects. Methods: A total of 240 outpatients without known diabetes who were previously admitted for coronary angiography underwent an oral glucose tolerance test. FGF-19 increment (pg/ml) was calculated as FGF-19 2 h after OGL minus fasting FGF-19. Results: Overall, FGF-19 significantly increased after OGL (from 123 [78~201] to 141 [80~237], p=0.001). By age tertiles (≦54, 55~64, ≧65), FGF-19 significantly increased only in patients aged ≧65 (from 143 [98~209] to 189 [124~332], p<0.001). By glucose regulation status, FGF-19 significantly increased in patients with normal glucose tolerance (from 117 [78~211] to 153 [106~325], p=0.014) and in patients with prediabetes (from 117 [73~179] to 123 [70~204], p=0.043), but not in patients with diabetes (from 181 [102~243] to 178 [111~275], p=0.139). FGF-19 significantly increased in patients on statin treatment (from 120 [78~207] to 145 [86~264], p<0.001), but not in patients not on statin therapy (from 125 [86~196] to 128 [68~230] pg/ml, p=0.676). These findings remained significant after adjustment for confounders. Conclusions: FGF-19 increment after OGL was positively associated with age, and negatively associated with abnormal glucose regulation and statin treatment.
    Full-text · Article · Sep 2015 · Clinica chimica acta; international journal of clinical chemistry
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    • "The glucometabolic state of patients admitted to the coronary care units with acute myocardial infarction, with or without diagnosis of diabetes, is an important marker of risk for long-term mortality. The Glucose in Acute Myocardial Infarction (GAMI) study [8] suggested that patients with myocardial infarction have a high prevalence of previously unknown T2DM and IGT and recent data from the EURO Heart Survey on Diabetes [9] have shown a high prevalence of T2DM or IGT in patients with chronic CAD. Nearly 20% of patients with myocardial infarction have a previously diagnosed T2DM [2] [10]; however if an Oral Glucose Tolerance Test (OGTT) is performed, the prevalence of diabetes becomes higher, presumably as high as 40–45% [8] [11]. "
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    ABSTRACT: Background The aim of this study is to examine the effect of an intensive CR program early after coronary artery bypass grafting on glucometabolic state of non-diabetic patients with CAD. Methods 60 patients were included in the study. All patients underwent Oral Glucose Tolerance Test (OGTT), Homeostasis Model Assessment (HOMA) Index and Six Minutes Walking Test at baseline and at the end of CR. The patients were then included in a 3-month follow-up program. Results At baseline 61% of the patients had normal fasting glucose, while after OGTT 28.3% had normal glucose tolerance, 41.6% had impaired glucose tolerance (IGT), and 30.1% had type 2 diabetes mellitus (T2DM). At the end of the CR program the number of patients with T2DM was significantly lower (− 22%, p < 0.05) while the number of normal glucose tolerance patients had significantly increased (+ 26%; p < 0.05). T2DM and IGT patients showed worse performances at Six Minutes Walking Test than normal glucose tolerance patients at baseline but had a similar improvement after 4 weeks of training. After 3 months follow-up fasting blood glucose, insulin levels and HOMA index were increased compared to 4 week values, but were lower than baseline. Conclusion OGTT is important to evaluate glucometabolic state of CAD patients. Intensive CR improves glucometabolic state and insulin resistance in CAD patients with impaired glucose metabolism.
    Full-text · Article · Jun 2014 · IJC Metabolic and Endocrine
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    • "Type 2 diabetes mellitus is a major risk factor for cardiovascular morbidity and mortality. It has been reported that among patients with coronary artery disease, approximately 35 and 15% have had diabetes or prediabetes, respectively1. In addition, individuals with high postload plasma glucose (PG) levels have a higher risk of cardiovascular and all‐cause mortality than individuals with high fasting plasma glucose (FPG) levels2. "
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    ABSTRACT: Aims/IntroductionThe inverse association between soybean intake and type 2 diabetes mellitus has been reported. We investigated the effects of soybean product intake on the incidence of type 2 diabetes mellitus considering fasting and postload hyperglycemia. Materials and Methods The present 4-year, cohort study included 1,738 men and 1,301 women, aged 30–69 years, without diabetes mellitus at baseline who underwent comprehensive medical check-ups between April 2006 and March 2007 at Saku Central Hospital. Participants were stratified by sex and body mass index (BMI), and further classified into three groups based on soybean product intake: group 1 (0–1 time/week), group 2 (2–3 times/week) and group 3 (four or more times per week). Participants underwent annual standard 75-g oral glucose tolerance testing during follow-up periods until March 2011. Main outcomes were incidence of fasting hyperglycemia, postload hyperglycemia and type 2 diabetes mellitus. ResultsDuring 10,503 person-years of follow up, 204 participants developed type 2 diabetes mellitus, including 61 who developed fasting hyperglycemia and 147 who developed postload hyperglycemia. Among men with a high BMI, group 3 had significantly lower risk for the incidence of type 2 diabetes mellitus, fasting hyperglycemia and postload hyperglycemia than group 1, and multivariable-adjusted hazard ratios and 95% confidence intervals were 0.44 (0.22–0.89), 0.36 (0.15–0.96) and 0.40 (0.18–0.92), respectively. Similar results were not observed among men with low BMI or women. Conclusions Soybean product intake prevented fasting and postload hyperglycemia and type 2 diabetes mellitus in men with a high BMI. Further long-term observation is necessary.
    Full-text · Article · Nov 2013
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