High incidence of glucose intolerance in Asian-Indian subjects with acute coronary syndrome.
OBJECTIVE
The risk of diabetes and coronary heart disease is high in Asian Indians. In this study, we aim to assess 1) the prevalence of hyperglycemia in incident acute coronary syndrome (ACS), 2) the effect of glycemia on the outcome, and 3) the association of plasma levels of insulin and proinsulin with ACS.


METHODS
A total of 146 nondiabetic subjects (121 men, 25 women) with ACS admitted to two hospitals in 1 year were enrolled. Random blood glucose at admission and a standard oral glucose tolerance test within 3 days were done. Glucose tolerance was categorized as normal glucose tolerance, impaired glucose tolerance (IGT) or impaired fasting glucose, and diabetes. Diabetes was arbitrarily classified further as undiagnosed (HbA1c [A1C] >6.0%) or possibly stress diabetes (A1C <6.0%). Subjects not on antidiabetic treatment were reassessed with a glucose tolerance test between 1 and 2 months. Fasting plasma specific insulin, proinsulin, their molar ratios, and insulin resistance (homeostasis model assessment) were estimated at baseline.


RESULTS
Mean age of the cohort was 55 +/- 10.6 (SD) years. At baseline, 24 (16.4%) had normal glucose tolerance, 67 (45.9%) had IGT or impaired fasting glucose, and 55 (37%) had diabetes (35 [24%] were undiagnosed and 20 [13.7%] had stress diabetes). At follow-up, 53 of 92 responders (57.6%) continued to have IGT or diabetes. Mean baseline plasma insulin, proinsulin and its ratios, and insulin resistance were higher than normal in all subgroups.


CONCLUSIONS
Nondiabetic Asian Indians showed a high prevalence of hyperglycemia following ACS. ACS was associated with insulin resistance and increased levels of specific insulin, proinsulin, and high proinsulin-to-insulin ratios.
Ramachandran
Ambady
A
Diabetes Research Centre, M.V. Hospital for Diabetes, WHO Collaborating Centre for Research, Education & Training in Diabetes, 4 Main Rd., Royapuram, Chennai-600 013, India. ramachandran@vsnl.com
Chamukuttan
Snehalatha
S
Immaneni
Sathyamurthy
S
Shanmugam
Ravi Marimuthu
RM
Vishnu
Nalini
N
Viswanathan
Vijay
V
Jaakko
Tuomilehto
T
D000208:Acute Disease; D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000208:ethnology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology; D005260:Female; D018149:Glucose Intolerance / Q000097:blood / Q000208:ethnology*; D006801:Humans; D006943:Hyperglycemia / Q000208:ethnology; D015994:Incidence; D007194:India / Q000453:epidemiology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011384:Proinsulin / Q000097:blood
D007328:Insulin; D011384:Proinsulin