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. 2019 Jan;67(1):43-49.
doi: 10.1111/jgs.15604. Epub 2018 Oct 9.

Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort

Richard Brandon Stacey  1 , Janice Zgibor  2 , Paul E Leaverton  2 , Douglas D Schocken  3 , Jennifer A Peregoy  2 , Mary F Lyles  4 , Alain G Bertoni  5 , Gregory L Burke  5
Affiliations

Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort

Richard Brandon Stacey et al. J Am Geriatr Soc. 2019 Jan.

Abstract

Objectives: To investigate glucose levels as a risk factor for unrecognized myocardial infarctions (UMIs).

Design: Cohort SETTING: Cardiovascular Health Study.

Participants: Individuals aged 65 and older with fasting glucose measurements (N=4,355; normal fasting glucose (NFG), n = 2,041; impaired fasting glucose (IFG), n = 1,706; DM: n = 608; 40% male, 84% white, mean age 72.4 ± 5.6).

Measurements: The relationship between glucose levels and UMI was examined. Participants with prior coronary heart disease (CHD) or UMI on initial electrocardiography were excluded. Using Minnesota codes, UMI was identified according to the presence of pathological Q-waves or minor Q-waves with ST-T abnormalities. Crude and adjusted hazard ratios (HRs) were calculated. Analyses were adjusted for age, sex, body mass index (BMI), hypertension, antihypertensive and lipid-lowering medication use, total cholesterol, high-density lipoprotein cholesterol, and smoking status.

Results: Over a mean follow-up of 6 years, there were 459 incident UMIs (NFG, n=202; IFG, n=183; DM, n=74). Participants with IFG were slightly more likely than those with NFG to experience a UMI (hazard ratio (HR)=1.11, 95% confidence interval (CI)=0.91-1.36, p = .30), and those with DM were more likely than those with NFG to experience a UMI (HR=1.65, 95% CI=1.25-2.13, p < .001). After adjustment HR for UMI in IFG those with IFG were no more likely than those with NFG to experience a UMI (HR=1.01, 95% CI=0.82-1.24, p = .93), whereas those with DM were more likely than those with NFG to experience a UMI (HR=1.37, 95% CI=1.02-1.81, p = .03). The 2-hour oral glucose tolerance test was not statistically significantly associated with UMI.

Conclusion: Fasting glucose status, particularly in the diabetic range, forecasted UMI during 6 years of follow-up in elderly adults. Further studies are needed to clarify the level of glucose at which risk is greater. J Am Geriatr Soc 67:43-49, 2019.

Keywords: elderly; electrocardiography; myocardial infarction.

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Conflict of interest statement

Conflict of Interest: None of the co-authors have any conflicts, financial or professional, related to this manuscript.

Figures

Figure 1.
Figure 1.
Bar chart demonstrating difference in incident unrecognized myocardial infarctions by fasting glucose status in the total cohort and stratified by gender (NFG: Normal Fasting Glucose; IFG: Impaired Fasting Glucose; DM: Diabetes Mellitus).
Figure 2.
Figure 2.
Kaplan-Meier Curve showing event-free survival of an Unrecognized Myocardial Infarction by Fasting Glucose Status. (NFG: Normal Fasting Glucose; IFG: Impaired Fasting Glucose; DM: Diabetes Mellitus).
See this image and copyright information in PMC

References

    1. Zhang ZM, Rautaharju PM, Prineas RJ, et al. Race and Sex Differences in the Incidence and Prognostic Significance of Silent Myocardial Infarction in the Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2016;133: 2141–2148. - PMC - PubMed
    1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. . 2017.
    1. Burgess DC, Hunt D, Li L, et al. Incidence and predictors of silent myocardial infarction in type 2 diabetes and the effect of fenofibrate: an analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. European heart journal. 2010;31: 92–99. - PubMed
    1. Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes care. 1999;22: 233–240. - PubMed
    1. Lundblad D, Eliasson M. Silent myocardial infarction in women with impaired glucose tolerance: the Northern Sweden MONICA study. Cardiovascular diabetology. 2003;2: 9. - PMC - PubMed

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