Related Experiment Videos
Diabetes status, fasting glucose and HbA1c, and outcomes after myocardial infarction: a retrospective registry-based
Azzum Haider1,2, Emil Hagström3,4, Divan Ishak5
1Uppsala Universitet, Uppsala, Sweden azzum.haider@uu.se.
Objectives:
This study aimed to assess cardiovascular (CV) risk across the full spectrum of dysglycaemia levels following myocardial infarction (MI).
Design:
Retrospective registry-based cohort study.
Setting:
All patients with MI in Sweden registered in the cardiac rehabilitation registry within the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) between 2006 and 2017.
Participants:
In total, 47 558 patients over the age of 18 attending cardiac rehabilitation post-MI, with available information on glycaemic levels.
Primary And Secondary Outcome Measures:
The primary outcome was major adverse CV events (MACE), a composite of all-cause mortality, MI and ischaemic stroke until the end of follow-up (30 June 2018). Secondary outcomes included all the components of MACE, CV mortality and hospitalisation for heart failure.
Results:
Pre-diabetes and possible diabetes were present in 20.6%, new-onset diabetes in 3.2% and known diabetes in 21.1%. During a median follow-up of 4.7 years, 9321 patients experienced MACE. A stepwise increase across glycaemic categories was observed, with HRs of 1.07 (95% CI 1.00 to 1.14) for pre-diabetes, 1.22 (95% CI 1.11 to 1.34) for possible diabetes, 1.22 (95% CI 1.08 to 1.37) for new-onset diabetes and 1.73 (95% CI 1.64 to 1.82) for known diabetes, compared with normoglycaemia. A near-linear association between fasting glucose and outcomes was observed across all patients, while glycated haemoglobin appears predictive mainly in those with established diabetes.
Conclusions:
Glycaemic disturbances early after MI, including hyperglycaemia below the diagnostic threshold for diabetes, are associated with a progressively higher risk of adverse outcomes. Beyond routine screening, these findings support close follow-up of at-risk patients, irrespective of diabetes status.
Related Concept Videos
Hyperglycemia
Type II Diabetes Mellitus III: Clinical Manifestations and Diagnosis
Diabetes: Symptoms, Diagnosis, and Complications
Diabetes Mellitus: Type 2 and Gestational
Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Diabetic Retinopathy