Hyperglycaemia, in relation to sex, and mortality after acute coronary syndrome.
OBJECTIVE
Both diabetes mellitus (DM) and hyperglycaemia are known to predict outcome after acute coronary syndrome (ACS). Recent work has suggested women with DM have greater baseline cardiovascular risk and poorer outcome after ACS. The interaction between sex and abnormal glucose homoeostasis in patients without diabetes is unexplored; we aimed to assess this relationship.


RESULTS
Retrospective analysis of data from a prospective cohort study of 1575 patients with a confirmed ACS and no previous diagnosis of DM in 11 UK hospitals. Multivariable analysis was performed to assess the value of clinical variables, including hyperglycaemia and sex, in predicting 2 year all-cause mortality. Sex and hyperglycaemia interacted in predicting mortality. In men, mortality risk increased more steeply with incremental levels of glycaemia than in women (glucose > or =11.1 mmol/l, hazard ratio, 2.19; 95% confidence interval, 1.2-4.0). In both sex groups increasing glycaemia predicted mortality at levels currently not recommended for acute therapeutic intervention (7.8-11.0 mmol/l).


CONCLUSIONS
In patients not known to have diabetes, hyperglycaemia is a concentration-dependent predictor of long-term mortality after ACS; this predictive value is stronger in men than women.
Cubbon
Richard M
RM
Leeds Institute for Genetics, Health and Therapeutics, The LIGHT Laboratories, Clarendon Way, Leeds, UK.
Rajwani
Adil
A
Abbas
Afroze
A
Gale
Christopher P
CP
Grant
Peter J
PJ
Wheatcroft
Stephen B
SB
Barth
Julian H
JH
Kearney
Mark T
MT
Hall
Alistair S
AS
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012727:Sex Characteristics