Fasting plasma glucose predicts survival and angiographic progression in high-risk postmenopausal women with coronary artery disease.
BACKGROUND
We studied the association of baseline fasting plasma glucose (FPG) levels with survival and coronary artery disease (CAD) progression among postmenopausal women without unstable angina.


METHODS
Women were recruited from seven centers in the Women's Angiographic Vitamin and Estrogen Trial (WAVE) (n = 423). Event follow-up was available for 400 women (65.1 +/- 8.5 years, 66% white, 92% hypertensive, 19% smokers, 67% hypercholesterolemic). Thirty-eight percent of the women had diabetes or FPG > 125 mg/dL, and 21% had a fasting glucose 100-125 mg/dL. Follow-up angiography was performed in 304 women. Cox regression was used to model survival from a composite outcome of death or myocardial infarction (D/MI, 26 events; median follow-up 2.4 years). Angiographic progression was analyzed quantitatively using linear regression accounting for baseline minimum lumen diameter (MLD), follow-up time, and intrasubject correlations using generalized estimating equations. Regression analyses were adjusted for follow-up time, baseline age, treatment assignment, and Framingham risk (excluding diabetes).


RESULTS
Women with impaired fasting glucose/diabetes mellitus (IFG/DM) had a relative risk (RR) of D/MI of 4.2 ( p = 0.009). In all women, each 10 mg/dL increase in FPG was associated with an 11% increase ( p < 0.001) in the hazard of D/MI. Each 10 mg/dL increase in FPG was associated with a 6.8 mum decrease in MLD over the follow-up period ( p = 0.005).


CONCLUSIONS
Higher FPG is associated with increased risk of D/MI and greater narrowing of the coronary lumen in women with CAD. Aggressive monitoring of glucose levels may be beneficial for secondary CAD prevention.
Vaidya
Dhananjay
D
Johns Hopkins University, Baltimore, Maryland 21287, USA. dvaidya1@jhmi.edu
Kelemen
Mark D
MD
Bittner
Vera
V
Tardif
Jean-Claude
JC
Thompson
Paul
P
Ouyang
Pamela
P
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000628:therapy; D048909:Diabetes Complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000517:prevention & control; D017698:Postmenopause; D015995:Prevalence; D016016:Proportional Hazards Models; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D016387:Women's Health
D001786:Blood Glucose