Publications (2)6.55 Total impact
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ABSTRACT: Data are limited regarding the best prognostic glucose measure for patients admitted for an acute coronary event. We examined the admission fasting glucose levels among patients with acute coronary syndrome (ACS) from the University of Michigan ACS registry. The glucose levels were grouped into 3 categories (> or =70 to <100, 100 to <126, and > or =126 mg/dl). The primary outcome measures included mortality and a composite end point (stroke, recurrent infarction, and death) in hospital and at 6 months after the ACS event. Of the 1,525 patients (29% with diabetes) for whom glucose levels were available, a fasting glucose level of > or =100 mg/dl was associated with increased in-hospital mortality, after adjusting for the Global Registry of Acute Coronary Events risk score and gender. A fasting glucose level of > or =126 mg/dl in patients with no known history of diabetes was associated with in-hospital adverse events (odds ratio 3.37, 95% confidence interval 1.51 to 7.51). The fasting glucose level was associated with an increased risk of 6-month mortality among nondiabetics (odds ratio 3.03, 95% confidence interval 1.35 to 6.81 for patients with a glucose level of 100 to 125 mg/dl; and odds ratio 2.81, 95% confidence interval 1.07 to 7.36 for patients with a glucose level of > or =126 mg/dl) but not for diabetic patients. In conclusion, we observed a strong association between the admission fasting glucose level and mortality, particularly among nondiabetic patients. Whether improving the diagnosis and treatment of hyperglycemia would result in reductions in adverse events after ACS remains unclear.
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ABSTRACT: Several studies have suggested that obesity may be associated with a survival advantage in heart failure (HF). The duration of HF likely influences disease severity and may introduce lead-time bias into analyses of outcomes. The aim of this study was to analyze a cohort in which the exact time of HF onset could be determined: patients in the University of Michigan subset of the acute coronary syndromes (ACS) database of the Global Registry of Acute Coronary Events (GRACE) who developed new-onset HF (no history of HF and left ventricular ejection fraction <or=40% or qualitatively diminished) with their index ACS events from January 1999 to March 2006 (n = 446). For analysis, body mass index (BMI) was categorized as normal (18.5 to <25 kg/m(2)), overweight (25 to <30 kg/m(2)), and obese (>or=30 kg/m(2)). Underweight patients (BMI <or=18.5 kg/m(2)) were excluded. Separate multivariate Cox regression models were performed to examine the effect of BMI group and other potential confounders on all-cause mortality and on the combined outcome of all-cause death, cardiac transplantation, or ventricular assist device implantation. BMI groups were not associated with different risks for the combined outcome, although overweight BMI approached statistical significance for lower risk for the combined outcome. Overweight BMI was significantly associated with lower risk for all-cause death (hazard ratio 0.63, 95% confidence interval 0.42 to 0.94, p = 0.02), although obese BMI was not (hazard ratio 1.06, 95% confidence interval 0.69 to 1.64, p = 0.8). In conclusion, these findings suggest a U-shaped relation between mortality and BMI in the setting of new-onset HF after ACS.
Concordia University–Ann ArborAnn Arbor, Michigan, United States
California Pacific Medical Center Research InstituteSan Francisco, California, United States