Post-challenge hyperglycaemia is strongly associated with future macrovascular events and total mortality in angiographied coronary patients

• Published in: European heart journal 2010-07, Vol.31 (13), p.1583-1590
• Main Authors: Sourij, Harald, Saely, Christoph H., Schmid, Fabian, Zweiker, Robert, Marte, Thomas, Wascher, Thomas C., Drexel, Heinz
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood Glucose - drug effects; Cardiology. Vascular system; Coronary Angiography; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary heart disease; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - mortality; Diabetes Mellitus, Type 2 - diagnostic imaging; Diabetes Mellitus, Type 2 - mortality; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - diagnostic imaging; Diabetic Angiopathies - mortality; Disease-Free Survival; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glucose Intolerance; Heart; Humans; Hyperglycemia - etiology; Hyperglycemia - mortality; Impaired glucose tolerance; Macrovascular risk; Male; Medical sciences; Middle Aged; Post-challenge hyperglycaemia
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehq099

Aims The prevalence of post-challenge hyperglycaemia in coronary patients is high. Until now, it is unclear whether post-challenge hyperglycaemia is associated with an increased risk for future macrovascular events in this clinically important patient population. Methods and results We enrolled 1040 patients undergoing coronary angiography for the evaluation of suspected or established coronary artery disease. In patients without previously established diabetes mellitus, an oral glucose tolerance test (oGTT) was performed. Prospectively, mortality and macrovascular events were recorded over a mean follow-up period of 3.8 years. From our patients, 394 had normal glucose tolerance (NGT), 280 post-challenge hyperglycaemia (this subgroup includes both impaired glucose tolerance and post-challenge diabetes) and 366 had conventional diabetes. The incidence of macrovascular events was significantly higher in patients with post-challenge hyperglycaemia as well as in patients with conventional diabetes than in subjects with NGT (23.6 and 29.5% vs. 18.5%; P = 0.013 and P < 0.001, respectively). Adjusted hazard ratios were 1.46 (95% CI 1.03–2.07, P = 0.033) for patients with post-challenge hyperglycaemia and 1.73 (1.25–2.37, P = 0.001) for patients with conventional diabetes. Conclusion Post-challenge hyperglycaemia is associated with future macrovascular events in patients undergoing coronary angiography for the evaluation of stable coronary artery disease (CAD). Oral glucose tolerance tests in this high-risk population thus identify patients with a particularly unfavourable prognosis.