HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tenerz, A. Articles by Malmberg, K. Search for Related Content PubMed PubMed Citation Articles by Tenerz, A. Articles by Malmberg, K. Social Bookmarking                What's this?

Diabetes, Insulin Resistance, and the Metabolic Syndrome in Patients With Acute Myocardial Infarction Without Previously Known Diabetes

¹ Department of Medicine, Central Hospital, Västerås, Sweden
² Centre for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden
³ Department of Cardiology, Karolinska Hospital, Stockholm, Sweden
⁴ Atherosclerosis Research Unit, King Gustaf V Research Institute, Karolinska Hospital, Stockholm, Sweden

Address correspondence and reprint requests to Åke Tenerz, MD, Department of Medicine, Central Hospital, SE 721 89 Västerås, Sweden. E-mail: ake.tenerz{at}telia.com

OBJECTIVE—Individuals with diabetes have an increased morbidity from acute myocardial infarction (AMI). Based on an oral glucose tolerance test (OGTT), 40–45% of patients with AMI have diabetes. The objective of this study was to characterize the glucometabolic profile of patients with AMI without known diabetes and to see if sustained glucometabolic perturbations are predictable during the hospital phase of the disease.

RESEARCH DESIGN AND METHODS—A total of 145 patients with AMI and no previous diagnosis of diabetes were subjected to an OGTT at hospital discharge and 3 months thereafter. Based on the OGTT after 3 months, they were defined as having normal glucose tolerance (NGT; n = 50), impaired glucose tolerance (IGT; n = 59), or diabetes (n = 36). Components of the metabolic syndrome, including insulin resistance assessed by homeostasis model assessment (HOMA-IR), were recorded.

RESULTS—Patients with AMI had no changes in insulin resistance from hospital discharge to follow-up. An OGTT and/or a single blood glucose taken 60 min (BG-60) after ingestion of 75 g glucose at hospital discharge were predictors of the outcome of the OGTT at follow-up. With a cutoff value for BG-60 of 8.6 mmol/l, 70% of the patients were correctly predicted as either belonging to the NGT group or the IGT/diabetes group after 3 months. Age, BMI, antihypertensive treatment, HbA_1c, fasting blood glucose, blood lipids, insulin, proinsulin, HOMA-IR, and plasminogen activator inhibitor 1 did not add predictive power.

CONCLUSIONS—Patients with AMI and no previous diagnosis of diabetes have no changes in insulin resistance from hospital discharge to a 3-month follow-up. An OGTT or a single BG-60 performed at hospital discharge predicts the diagnosis of IGT or diabetes 3 months thereafter.

Abbreviations: AMI, acute myocardial infarction • BG-60, blood glucose after 60 min • BG-120, blood glucose after 120 min • FBG, fasting blood glucose • HOMA-IR, homeostatis model assessment of insulin resistance • IGT, impaired glucose tolerance • NGT, normal glucose tolerance • OGTT, oral glucose tolerance test • PAI-1, plasminogen activator inhibitor 1 • WHO, World Health Organization

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				T. Amano, T. Matsubara, T. Uetani, M. Nanki, N. Marui, M. Kato, T. Yoshida, K. Arai, K. Yokoi, H. Ando, et al. Abnormal Glucose Regulation Is Associated With Lipid-Rich Coronary Plaque: Relationship to Insulin Resistance J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 39 - 45. [Abstract] [Full Text] [PDF]

				M. Timonen, I. Salmenkaita, J. Jokelainen, M. Laakso, P. Harkonen, P. Koskela, V. B. Meyer-Rochow, A. Peitso, and S. Keinanen-Kiukaanniemi Insulin Resistance and Depressive Symptoms in Young Adult Males: Findings From Finnish Military Conscripts Psychosom Med, October 1, 2007; 69(8): 723 - 728. [Abstract] [Full Text] [PDF]

				M Bartnik, L Ryden, K Malmberg, J Ohrvik, K Pyorala, E Standl, R Ferrari, M Simoons, J Soler-Soler, and on behalf of the Euro Heart Survey Investigators Oral glucose tolerance test is needed for appropriate classification of glucose regulation in patients with coronary artery disease: a report from the Euro Heart Survey on Diabetes and the Heart Heart, January 1, 2007; 93(1): 72 - 77. [Abstract] [Full Text] [PDF]

				D.-Y. Hu, C.-Y. Pan, J.-M. Yu, and for the China Heart Survey Group The relationship between coronary artery disease and abnormal glucose regulation in China: the China Heart Survey Eur. Heart J., November 1, 2006; 27(21): 2573 - 2579. [Abstract] [Full Text] [PDF]

				M. Ishihara, I. Inoue, T. Kawagoe, Y. Shimatani, S. Kurisu, T. Hata, Y. Nakama, Y. Kijima, and E. Kagawa Is admission hyperglycaemia in non-diabetic patients with acute myocardial infarction a surrogate for previously undiagnosed abnormal glucose tolerance? Eur. Heart J., October 2, 2006; 27(20): 2413 - 2419. [Abstract] [Full Text] [PDF]

				J. W. A. Smit and J. A. Romijn Acute insulin resistance in myocardial ischemia: causes and consequences. Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2006; 10(3): 215 - 219. [Abstract] [PDF]

				K. Nishio, M. Sakurai, T. Kusuyama, M. Shigemitsu, T. Fukui, K. Kawamura, S. Itoh, N. Konno, and T. Katagiri A Randomized Comparison of Pioglitazone to Inhibit Restenosis After Coronary Stenting in Patients With Type 2 Diabetes Diabetes Care, January 1, 2006; 29(1): 101 - 106. [Abstract] [Full Text] [PDF]

				M. Kosiborod, S. S. Rathore, S. E. Inzucchi, F. A. Masoudi, Y. Wang, E. P. Havranek, and H. M. Krumholz Admission Glucose and Mortality in Elderly Patients Hospitalized With Acute Myocardial Infarction: Implications for Patients With and Without Recognized Diabetes Circulation, June 14, 2005; 111(23): 3078 - 3086. [Abstract] [Full Text] [PDF]

				K. Hashimoto, K. Ikewaki, H. Yagi, H. Nagasawa, S. Imamoto, T. Shibata, and S. Mochizuki Glucose Intolerance Is Common in Japanese Patients With Acute Coronary Syndrome Who Were Not Previously Diagnosed With Diabetes Diabetes Care, May 1, 2005; 28(5): 1182 - 1186. [Abstract] [Full Text] [PDF]

				M. Timonen, U. Rajala, M. Laakso, and J. Jokelainen Insulin resistance and depression: Authors' reply BMJ, April 23, 2005; 330(7497): 965 - 966. [Full Text]

				M. Bartnik, K. Malmberg, A. Norhammar, A. Tenerz, J. Ohrvik, and L. Ryden Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction Eur. Heart J., November 2, 2004; 25(22): 1990 - 1997. [Abstract] [Full Text] [PDF]

				M. Bartnik, L. Ryden, R. Ferrari, K. Malmberg, K. Pyorala, M. Simoons, E. Standl, J. Soler-Soler, J. Ohrvik, and on behalf of the Euro Heart Survey Investigators The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe: The Euro Heart Survey on diabetes and the heart Eur. Heart J., November 1, 2004; 25(21): 1880 - 1890. [Abstract] [Full Text] [PDF]