Glycosylated hemoglobin is associated with decreased endothelial function, high inflammatory response, and adverse clinical outcome in non-diabetic STEMI patients

Atherosclerosis. 2015 Nov;243(1):124-30. doi: 10.1016/j.atherosclerosis.2015.09.004. Epub 2015 Sep 8.

Abstract

Objective: Chronic dysglycemia was recently identified as a predictor for adverse outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention. Data for non-diabetic patients who underwent thrombolysis is scarce. In this context, we aimed to study the effect of HbA1c on cardiovascular outcome after STEMI.

Methods: A prospective cohort of 326 non-diabetic STEMI individuals was used for the analyses. We measured plasma glucose, hemoglobin A1c [HbA1c], lipid profile, C-reactive protein (CRP), and nitrate/nitrite (NOx) upon admission and five days after STEMI (D5). Flow-mediated dilation (FMD) was performed 30 days after STEMI. During clinical follow-up, we assessed patients for incident diabetes (progression to HbA1c ≥ 6.5%) and major adverse cardiac events (MACE), defined as a composite of fatal and non-fatal MI, sudden cardiac death, and angina requiring hospitalization.

Results: Using ROC-curve analysis, a 5.8% HbA1c best predicted MACE with a sensitivity of 75% and specificity of 53% (AUC 0.673, p = 0.001). Patients were categorized as high HbA1c if ≥ 5.8% and low HbA1c if <5.8%. Compared with patients with low HbA1c, those with high HbA1c presented with 20% higher CRP-D5 (p = 0.009) and 19% higher ΔCRP (p = 0.01), a 32% decrease in ΔNOx (p < 0.001), and 33% lower FMD (p < 0.001). After a median follow-up of 1.9 (1.1-2.8) years, patients with high HbA1c had more incident diabetes (HR 2.3 95% CI 1.01-5.2; p = 0.048) and MACE (HR 3.32 95% CI 1.09-10.03; p = 0.03).

Conclusion: Non-diabetic STEMI patients with high HbA1c present with decreased endothelial function and increased inflammatory response and long-term risk of MACE.

Keywords: Follow-up study; Glycosylated hemoglobin; Mortality; Myocardial infarction; Nitric oxide.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Glucose / analysis
  • Brachial Artery / pathology
  • C-Reactive Protein / analysis
  • Coronary Angiography
  • Diabetes Mellitus
  • Diet
  • Endothelium, Vascular / physiopathology*
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin / analysis*
  • Humans
  • Inflammation
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Myocardial Infarction / blood*
  • Myocardial Infarction / complications
  • Nitric Oxide / chemistry
  • Patient Admission
  • Percutaneous Coronary Intervention
  • Prospective Studies
  • ROC Curve
  • Risk Factors
  • Sensitivity and Specificity
  • Treatment Outcome

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Nitric Oxide
  • C-Reactive Protein