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Impaired glucose regulation, elevated glycated haemoglobin and cardiac ischaemic events in vascular surgery patients
Author(s) -
Feringa H. H. H.,
Vidakovic R.,
Karagiannis S. E.,
Dunkelgrun M.,
Elhendy A.,
Boersma E.,
Van Sambeek M. R. H. M.,
Noordzij P. G.,
Bax J. J.,
Poldermans D.
Publication year - 2008
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2007.02352.x
Subject(s) - medicine , diabetes mellitus , myocardial infarction , cardiac surgery , cardiology , glycated hemoglobin , endocrinology , troponin , troponin t , impaired glucose tolerance , ischemia , perioperative , type 2 diabetes , surgery
Aims Cardiac morbidity and mortality is high in patients undergoing high‐risk surgery. This study investigated whether impaired glucose regulation and elevated glycated haemoglobin (HbA 1c ) levels are associated with increased cardiac ischaemic events in vascular surgery patients. Methods Baseline glucose and HbA 1c were measured in 401 vascular surgery patients. Glucose < 5.6 mmol/l was defined as normal. Fasting glucose 5.6–7.0 mmol/l or random glucose 5.6–11.1 mmol/l was defined as impaired glucose regulation. Fasting glucose ≥ 7.0 or random glucose ≥ 11.1 mmol/l was defined as diabetes. Perioperative ischaemia was identified by 72‐h Holter monitoring. Troponin T was measured on days 1, 3 and 7 and before discharge. Cardiac death or Q‐wave myocardial infarction was noted at 30‐day and longer‐term follow‐up (mean 2.5 years). Results Mean (± sd ) level for glucose was 6.3 ± 2.3 mmol/l and for HbA 1c 6.2 ± 1.3%. Ischaemia, troponin release, 30‐day and long‐term cardiac events occurred in 27, 22, 6 and 17%, respectively. Using subjects with normal glucose levels as the reference category, multivariate analysis revealed that patients with impaired glucose regulation and diabetes were at 2.2‐ and 2.6‐fold increased risk of ischaemia, 3.8‐ and 3.9‐fold for troponin release, 4.3‐ and 4.8‐fold for 30‐day cardiac events and 1.9‐ and 3.1‐fold for long‐term cardiac events. Patients with HbA 1c > 7.0% ( n = 63, 16%) were at 2.8‐fold, 2.1‐fold, 5.3‐fold and 5.6‐fold increased risk for ischaemia, troponin release, 30‐day and long‐term cardiac events, respectively. Conclusions Impaired glucose regulation and elevated HbA 1c are risk factors for cardiac ischaemic events in vascular surgery patients.