Oral glucose tolerance test predicts increased carotid plaque burden in patients with acute coronary syndrome

• Published in: PloS one 2017-08, Vol.12 (8), p.e0183839-e0183839
• Main Authors: Bjarnason, Thorarinn A, Hafthorsson, Steinar O, Kristinsdottir, Linda B, Oskarsdottir, Erna S, Aspelund, Thor, Sigurdsson, Sigurdur, Gudnason, Vilmundur, Andersen, Karl
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - complications; Acute coronary syndromes; Aged; Arteries; Arteriosclerosis; Atherosclerosis; Biology and Life Sciences; Blood Glucose - metabolism; Cardiology; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Carotid arteries; Carotid artery; Carotid Artery Diseases - blood; Carotid Artery Diseases - complications; Carotid Artery Diseases - pathology; Coronary vessels; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Fasting; Fasting - blood; Female; Glucose; Glucose metabolism; Glucose tolerance; Glucose tolerance test; Glucose Tolerance Test - methods; Glycated Hemoglobin A - metabolism; Health risks; Health sciences; Heart; Hemoglobin; Hospitals; Humans; Hypertension; Laboratory testing; Linear Models; Male; Medical diagnosis; Medicine; Medicine and Health Sciences; Metabolism; Middle Aged; Patients; Plaque, Atherosclerotic - blood; Plaque, Atherosclerotic - complications; Plaque, Atherosclerotic - pathology; Prediabetic State - blood; Prediabetic State - diagnosis; Predictive Value of Tests; Prognosis; Reproducibility of Results; Risk analysis; Risk Factors; Severity of Illness Index; Ultrasonic imaging; Ultrasound; Young adults
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0183839

Type 2 diabetes and prediabetes are established risk factors for atherosclerosis. The aim of this study was to evaluate the atherosclerotic plaque burden in the carotid arteries of patients with acute coronary syndrome according to their glycemic status. Patients with acute coronary syndrome and no previous history of type 2 diabetes were consecutively included in the study. Glucose metabolism was evaluated with fasting glucose in plasma, HbA1c and a standard two-hour oral glucose tolerance test. Atherosclerotic plaque in the carotid arteries was evaluated with a standardized ultrasound examination where total plaque area was measured and patients classified as having no plaque or a significant plaque formation. A total of 245 acute coronary syndrome patients (male 78%, 64 years (SD: 10.9)) were included. The proportion diagnosed with normal glucose metabolism, prediabetes and type 2 diabetes was 28.6%, 64.1% and 7.3%, respectively. A significant atherosclerotic plaque was found in 48.5%, 66.9% and 72.2% of patients with normal glucose metabolism, prediabetes and type 2 diabetes, respectively. An incremental increase in total plaque area was found from normal glucose metabolism to prediabetes (25.5%) and from normal glucose metabolism to type 2 diabetes (35.9%) (p = 0.04). When adjusted for conventional cardiovascular risk factors the OR of having significant atherosclerotic plaque in the carotid arteries was 2.17 (95% CI 1.15-4.15) for patients with newly diagnosed dysglycemia compared to patients with normal glucose metabolism. When additionally adjusted for the 2-hour plasma glucose after glucose loading (2hPG) the OR attenuated to 1.77 (95% CI 0.83-3.84). Newly detected dysglycemia is an independent predictor of significant atherosclerotic plaque in the carotid arteries with oral glucose tolerance test as a major determinant of carotid plaque burden in this group of individuals with acute coronary syndrome.