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Unrecognized glycometabolic disturbance as measured by hemoglobin A1c is associated with a poor outcome after acute

Ida Gustafsson1, Caroline N Kistorp, Margaret K James

  • 1Department of Medicine, Roskilde University Hospital, Roskilde, Denmark. gustafsson@dadlnet.dk

American Heart Journal
|August 28, 2007
PubMed

Insights

Glycated hemoglobin A1c (HbA1c) predicts mortality in high-risk myocardial infarction (MI) patients without known diabetes. Higher HbA1c levels correlated with increased mortality risk in this group, but not in those with diagnosed diabetes.

Area of Science:

  • Cardiology
  • Endocrinology
  • Clinical Research

Background:

  • Glycated hemoglobin A1c (HbA1c) reflects average blood glucose over 2 months, minimally affected by acute hyperglycemia during myocardial infarction (MI).
  • Assessing HbA1c's prognostic value in high-risk MI patients with and without diabetes history is crucial.

Purpose of the Study:

  • To investigate the prognostic impact of HbA1c on mortality in patients with MI, specifically comparing those with and without a history of diabetes.

Main Methods:

  • Analysis of data from the OPTIMAAL trial involving 2841 MI patients with heart failure.
  • Patients were randomized to losartan or captopril; HbA1c was measured at randomization.
  • Patients without diabetes history were stratified by HbA1c levels (<4.9%, 4.9%-5.1%, >5.1%).

Main Results:

  • Mortality rate was 18% in patients with a history of diabetes.
  • Among patients without diabetes history, mortality increased with higher HbA1c levels (13% to 22%).
  • A 1% increase in HbA1c in non-diabetic patients raised mortality by 24%; HbA1c did not impact mortality in patients with known diabetes.

Conclusions:

  • HbA1c is a potent predictor of mortality in high-risk MI patients without previously known diabetes.
  • This finding highlights the importance of glycemic control assessment in MI patients, even those undiagnosed with diabetes.
Abstract

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