Objective ?To explore the glucometabolic state of angiographically documented inpatients with coronary artery disease (CAD) but without diagnosed diabetes mellitus (DM).
Methods ?The study recruited 449 patients, who were performed a coronary angiography as well as an oral glucose tolerance test (OGTT) when admitted in the cardiovascular medical ward in our hospital from January 2007 to May 2009. According to the results of coronary angiography, the patients were divided into a coronary artery disease (CAD) group and a non-coronary artery disease (non-CAD) group, and abnormal glucose metabolism (AGM) status was compared between the two groups.
Results ?The random plasma glucose (RPG) and fasting plasma glucose (FPG) had no significant differences (P values were 0.249 and 0.444, respectively) in the two groups, while the OGTT 2-hour plasma glucose (2hPG) was much higher in the CAD group, with a significant difference (P lt;0.001) compared with the non-CAD group. The CAD group had a prevalence of AGM up to 74.0%, of which 32.1% were newly diagnosed DM patients, and 39.0% were impaired glucose tolerance (IGT) patients, much higher than that in the non-CAD group, respectively, there being a significant difference (P=0.006). Logistic regression analyses revealed that the risk of IGT and newly diagnosed DM was 1.6 times (OR=1.603, 95% CI 1.023 to 2.512, P=0.04) and 2.3 times (OR=2.292, 95% CI 1.391 to 3.777, P=0.001) as much as that in non-CAD patients, respectively; when adjusted for the factors such as hypertension, dyslipidemia, BMI, hs-CRP, and other factors, CAD patients still had a higher risk of newly diagnosed DM (OR=1.852, 95%CI 1.064 to 3.223, P=0.029), compared with the non-CAD patients.
Conclusion ?AGM is common in the admitted patients with CAD but undiagnosed diabetes, most of whom need an OGTT to be diagnosed timely and accurately. OGTT should be considered to be a routine inspection item to diagnose AGM in the inpatients with CAD; if possible, all hospitalized patients with cardiovascular disease should be performed an OGTT routinely.
Citation：
WEN Zhuzhi,ZHANG Lan,ZHANG Yamei,WANG Jingfeng,GENG Dengfeng. Glucometabolic State of Patients with Coronary Artery Disease but without Diagnosed Diabetes. Chinese Journal of Evidence-Based Medicine, 2010, 10(8): 892-896. doi: 10.7507/1672-2531.20100515
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Copyright © the editorial department of Chinese Journal of Evidence-Based Medicine of West China Medical Publisher. All rights reserved
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DECODE Study Group, the European Diabetes Epidemiology Group. Glucose tolerance and cardiovascular mortality: Comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med, 2001, 161: 397-405.
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Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care,1997, 20: 537-544.
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Chiasson JL, Josse RG, Gomis R, et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: The STOPNIDDM trial. JAMA, 2003, 290: 486-494.
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Bartnik M, Ryde´n L, Malmberg KO, et al. on behalf of the Euro Heart Survey Investigators. Oral glucose tolerance test is needed for appropriate classification of glucose regulation in patients with coronary artery disease. Heart, 2007, 93: 72-77.
|
- 1. Hu DY, Pan CY, Yu JM, for the China Heart Survey Group. The relationship between coronary artery disease and abnormal glucose regulation in China: the China Heart Survey. Eur Heart J, 2006, 27: 2573-2579.
- 2. Bartnik M, Ryden L, Ferrari R, et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe: the Euro Heart Survey on diabetes and the heart. Eur Heart J, 2004, 25: 1880-1890.
- 3. Stern MP. Diabetes and cardiovascular disease. The "common soil" hypothesis. Diabetes, 1995, 44(4): 369-374.
- 4. Barr EL, Zimmet PZ, Welborn TA, et al. Risk of Cardiovascular and All-Cause Mortality in Individuals With Diabetes Mellitus, Impaired Fasting Glucose, and Impaired Glucose Tolerance The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation, 2007, 116: 151-157.
- 5. Norhammar A, Malmberg K, Diderholm E, et al. Diabetes mellitus: The major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization. J Am Coll Cardiol, 2004, 43: 585-591.
- 6. Tamita K, Katayama M, Takagi T, et al. Impact of Newly Diagnosed Abnormal Glucose Tolerance on Long-Term Prognosis in Patients With Acute Myocardial Infarction. Circ J, 2007, 71: 834-841.
- 7. DECODE Study Group, the European Diabetes Epidemiology Group. Glucose tolerance and cardiovascular mortality: Comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med, 2001, 161: 397-405.
- 8. Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care,1997, 20: 537-544.
- 9. Chiasson JL, Josse RG, Gomis R, et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: The STOPNIDDM trial. JAMA, 2003, 290: 486-494.
- 10. Bartnik M, Ryde´n L, Malmberg KO, et al. on behalf of the Euro Heart Survey Investigators. Oral glucose tolerance test is needed for appropriate classification of glucose regulation in patients with coronary artery disease. Heart, 2007, 93: 72-77.
