Abnormal glucose tolerance--a common risk factor in patients with acute myocardial infarction in comparison with population-based controls.
BACKGROUND
A high prevalence of newly detected diabetes and impaired glucose tolerance (abnormal glucose tolerance) was recently reported in patients with acute myocardial infarction. It is important to verify whether this finding is specific for the patients or attributable to the population, from which they were recruited.


OBJECTIVE
To verify whether abnormal glucose tolerance is more prevalent in patients than in controls chosen from the same population and to compare metabolic characteristics between the two groups.


METHODS
The metabolic state was assessed in patients (n = 181) admitted with acute myocardial infarction and no history of diabetes before discharge and after 3 months. Sex- and age-matched controls (n = 185) without previously known diabetes or cardiovascular disease except hypertension were recruited from the general population.


METHODS
Oral glucose tolerance test, glucosylated haemoglobin A1c (HbA1c), insulin, proinsulin, lipid profile, fibrinolytic function and inflammatory markers.


RESULTS
Abnormal glucose tolerance was more common (number/all classified) in patients at discharge 113/168 (67%) and after 3 months 95/145 (66%) than in controls 65/185 (35%) (P < 0.001). Dyslipidaemia (70% vs. 29%; P < 0.001) and previously treated hypertension (32% vs. 18%; P = 0.028) were more frequent amongst patients whilst obesity (18% vs. 24%) did not differ significantly. Blood glucose, HbA1c, proinsulin, proinsulin/insulin ratio, triglycerides, insulin resistance (by HOMA) and fibrinogen were consistently higher in patients than controls (P < 0.01).


CONCLUSIONS
Abnormal glucose tolerance was almost twice as common amongst patients with acute myocardial infarction as in matched controls. Impaired glycaemic control accompanied by insulin resistance, dyslipidaemia, hypertension, together with increased plasma fibrinogen and proinsulin levels were main features characterizing patients.
Bartnik
M
M
Department of Cardiology, Karolinska University Hospital, Solna, 171-76 Stockholm, Sweden. malgorzata.bartnik@medks.ki.se
Malmberg
K
K
Hamsten
A
A
Efendic
S
S
Norhammar
A
A
Silveira
A
A
Tenerz
A
A
Ohrvik
J
J
Rydén
L
L
D000208:Acute Disease; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005951:Glucose Tolerance Test / Q000379:methods; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000378:metabolism; D006973:Hypertension / Q000150:complications / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D008055:Lipids / Q000097:blood; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000378:metabolism*; D011384:Proinsulin / Q000097:blood; D011446:Prospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D005340:Fibrinogen; D006442:Glycated Hemoglobin; D008055:Lipids; D011384:Proinsulin; D014280:Triglycerides