title: Impaired fasting glucose is associated with increased perioperative cardiovascular event rates in patients undergoing major non-cardiothoracic surgery.
abstract: BACKGROUND
  Diabetes mellitus (DM) is a well-established risk factor for perioperative cardiovascular morbidity and mortality in patients undergoing noncardiac surgery. However, the impact of preoperative glucose levels on perioperative cardiovascular outcomes in patients undergoing nonemergent, major noncardiothoracic surgery is unclear.
  
  
  RESULTS
  A total of 680 patients undergoing noncardiothoracic surgery were prospectively evaluated. Patients older than 18 years who underwent an elective, nonday case, open surgical procedure were enrolled. Electrocardiography and cardiac biomarkers were obtained 1 day before surgery, and on days 1, 3 and 7 after surgery. Preoperative risk factors and laboratory test results were measured and evaluated for their association with the occurrence of in-hospital perioperative cardiovascular events. Impaired fasting glucose (IFG) defined as fasting plasma glucose values of 100 to 125 mg/dl; DM was defined as fasting plasma glucose ≥ 126 mg/dl and/or plasma glucose ≥ 200 mg/dl or the current use of blood glucose-lowering medication, and glucose values below 100 mg/dl were considered normal. Plasma glucose levels were significantly higher in patients with perioperative cardiovascular events (n=80, 11.8%) in comparison to those without cardiovascular events (131 ± 42.5 vs 106.5 ± 37.5, p < 0.0001). Multivariate analysis revealed that patients with IFG and DM were at 2.1- and 6.4-fold increased risk of perioperative cardiovascular events, respectively. Every 10 mg/dl increase in preoperative plasma glucose levels was related to a 11% increase for adverse perioperative cardiovascular events.
  
  
  CONCLUSIONS
  Not only DM but also IFG is associated with increased perioperative cardiovascular event rates in patients undergoing noncardiothoracic surgery.
authors.affiliation: Haydarpaşa Numune Education and Research Hospital, Department of Cardiology, Istanbul, Turkey. murbit2@yahoo.com
authors.forename: Murat
authors.initials: M
authors.lastname: Biteker
authors.forename: Akin
authors.initials: A
authors.lastname: Dayan
authors.forename: Mehmet M
authors.initials: MM
authors.lastname: Can
authors.forename: Erkan
authors.initials: E
authors.lastname: İlhan
authors.forename: Funda S
authors.initials: FS
authors.lastname: Biteker
authors.forename: Ahmet
authors.initials: A
authors.lastname: Tekkeşin
authors.forename: Dursun
authors.initials: D
authors.lastname: Duman
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D048909:Diabetes Complications / Q000097:blood / Q000150:complications; D013505:Digestive System Surgical Procedures; D005215:Fasting / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology; D059035:Perioperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology; D013520:Urologic Surgical Procedures
chemical_list: D001786:Blood Glucose