title: Impaired glucose regulation, elevated glycated haemoglobin and cardiac ischaemic events in vascular surgery patients.
abstract: OBJECTIVE
  Cardiac morbidity and mortality is high in patients undergoing high-risk surgery. This study investigated whether impaired glucose regulation and elevated glycated haemoglobin (HbA(1c)) levels are associated with increased cardiac ischaemic events in vascular surgery patients.
  
  
  METHODS
  Baseline glucose and HbA(1c) were measured in 401 vascular surgery patients. Glucose < 5.6 mmol/l was defined as normal. Fasting glucose 5.6-7.0 mmol/l or random glucose 5.6-11.1 mmol/l was defined as impaired glucose regulation. Fasting glucose > or = 7.0 or random glucose > or = 11.1 mmol/l was defined as diabetes. Perioperative ischaemia was identified by 72-h Holter monitoring. Troponin T was measured on days 1, 3 and 7 and before discharge. Cardiac death or Q-wave myocardial infarction was noted at 30-day and longer-term follow-up (mean 2.5 years).
  
  
  RESULTS
  Mean (+/- sd) level for glucose was 6.3 +/- 2.3 mmol/l and for HbA(1c) 6.2 +/- 1.3%. Ischaemia, troponin release, 30-day and long-term cardiac events occurred in 27, 22, 6 and 17%, respectively. Using subjects with normal glucose levels as the reference category, multivariate analysis revealed that patients with impaired glucose regulation and diabetes were at 2.2- and 2.6-fold increased risk of ischaemia, 3.8- and 3.9-fold for troponin release, 4.3- and 4.8-fold for 30-day cardiac events and 1.9- and 3.1-fold for long-term cardiac events. Patients with HbA(1c) > 7.0% (n = 63, 16%) were at 2.8-fold, 2.1-fold, 5.3-fold and 5.6-fold increased risk for ischaemia, troponin release, 30-day and long-term cardiac events, respectively.
  
  
  CONCLUSIONS
  Impaired glucose regulation and elevated HbA(1c) are risk factors for cardiac ischaemic events in vascular surgery patients.
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: H H H
authors.initials: HH
authors.lastname: Feringa
authors.forename: R
authors.initials: R
authors.lastname: Vidakovic
authors.forename: S E
authors.initials: SE
authors.lastname: Karagiannis
authors.forename: M
authors.initials: M
authors.lastname: Dunkelgrun
authors.forename: A
authors.initials: A
authors.lastname: Elhendy
authors.forename: E
authors.initials: E
authors.lastname: Boersma
authors.forename: M R H M
authors.initials: MR
authors.lastname: van Sambeek
authors.forename: P G
authors.initials: PG
authors.lastname: Noordzij
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
authors.forename: D
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000097:blood / Q000503:physiopathology*; D005260:Female; D018149:Glucose Intolerance / Q000097:blood / Q000503:physiopathology*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D011379:Prognosis; D014656:Vascular Surgical Procedures
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin