Fasting but not postprandial (postmeal) glycemia predicts the risk of death in subjects with coronary artery disease.
BACKGROUND
Chronic hyperglycemia plays a role in the pathogenesis of coronary artery disease (CAD); however, the cut-off level beyond which glycemia becomes detrimental is still controversial. Postprandial glycemia may be a stronger CAD risk factor than fasting glycemia in patients without documented heart disease.


OBJECTIVE
To identify the contributions of fasting and postprandial glycemia to cardiovascular risk in patients with documented coronary artery disease.


METHODS
The Coronary Artery Surgery Study (CASS) registry is a database of 24,958 patients with suspected or proven CAD who underwent cardiac catheterization between 1974 and 1979. Median long-term follow up was 14.7 years (interquartile range 9.8 to 16.2 years). Clinical outcomes were evaluated according to fasting glucose levels and 2 h postprandial (postmeal) plasma glucose (2hPG) levels. A total of 13,176 patients with baseline fasting glucose levels and 1691 patients with 2hPG levels were identified.


RESULTS
Impaired fasting glycemia was associated with a 1.2-fold increase in both all-cause and cardiovascular mortality (adjusted hazard ratio 1.23; 95% CI 1.08 to 1.40 for cardiovascular mortality), while undiagnosed diabetes was associated with a 1.5-fold increased risk for the same end points. Postprandial hyperglycemia (2hPG of 7.8 mmol/L to 11.0 mmol/L following an average meal) was not associated with a significant risk of death after adjustment for traditional risk factors or in the presence of fasting glucose of less than 6.1 mmol/L.


CONCLUSIONS
In CAD patients, impaired fasting glucose is associated with increased all-cause and cardiovascular mortality, whereas postprandial hyperglycemia following an average meal does not appear to be a risk factor.
Nigam
Anil
A
Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Bourassa
Martial G
MG
Fortier
Annik
A
Guertin
Marie-Claude
MC
Tardif
Jean-Claude
JC
D001786:Blood Glucose; D002318:Cardiovascular Diseases; D003324:Coronary Artery Disease / Q000401:mortality* / Q000503:physiopathology; D019992:Databases as Topic; D005215:Fasting; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology; D019518:Postprandial Period; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors
D001786:Blood Glucose