High Incidence of Glucose Intolerance in Asian-Indian Subjects With Acute Coronary Syndrome

  1. Ambady Ramachandran, MD, PHD, DSC, FRCP1,
  2. Snehalatha Chamukuttan, MSC, DPHIL, DSC1,
  3. Sathyamurthy Immaneni, MD, DM2,
  4. Ravi Marimuthu Shanmugam, MD, DM1,
  5. Nalini Vishnu, MSC1,
  6. Vijay Viswanathan, MD, PHD1 and
  7. Tuomilehto Jaakko, MD, PHD345
  1. 1Diabetes Research Centre, M.V. Hospital for Diabetes, WHO Collaborating Centre for Research, Education & Training in Diabetes, Royapuram, Chennai, India
  2. 2Apollo Hospital, Chennai, India
  3. 3Department of Public Health, University of Helsinki, Helsinki, Finland
  4. 4South Ostrobothnia Central Hospital, Seinajoki, Finland
  5. 5National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki, Finland
  1. Address correspondencereprint requests to Prof. A. Ramachandran, Director, Diabetes Research Centre, M.V. Hospital for Diabetes & WHO Collaborating Centre for Research, Education & Training in Diabetes, 4 Main Rd., Royapuram, Chennai-600 013, India. E-mail: ramachandran{at}


OBJECTIVE—The risk of diabetes and coronary heart disease is high in Asian Indians. In this study, we aim to assess 1) the prevalence of hyperglycemia in incident acute coronary syndrome (ACS), 2) the effect of glycemia on the outcome, and 3) the association of plasma levels of insulin and proinsulin with ACS.

RESEARCH DESIGN AND METHODS—A total of 146 nondiabetic subjects (121 men, 25 women) with ACS admitted to two hospitals in 1 year were enrolled. Random blood glucose at admission and a standard oral glucose tolerance test within 3 days were done. Glucose tolerance was categorized as normal glucose tolerance, impaired glucose tolerance (IGT) or impaired fasting glucose, and diabetes. Diabetes was arbitrarily classified further as undiagnosed (HbA1c [A1C] >6.0%) or possibly stress diabetes (A1C <6.0%). Subjects not on antidiabetic treatment were reassessed with a glucose tolerance test between 1 and 2 months. Fasting plasma specific insulin, proinsulin, their molar ratios, and insulin resistance (homeostasis model assessment) were estimated at baseline.

RESULTS—Mean age of the cohort was 55 ± 10.6 (SD) years. At baseline, 24 (16.4%) had normal glucose tolerance, 67 (45.9%) had IGT or impaired fasting glucose, and 55 (37%) had diabetes (35 [24%] were undiagnosed and 20 [13.7%] had stress diabetes). At follow-up, 53 of 92 responders (57.6%) continued to have IGT or diabetes. Mean baseline plasma insulin, proinsulin and its ratios, and insulin resistance were higher than normal in all subgroups.

CONCLUSIONS—Nondiabetic Asian Indians showed a high prevalence of hyperglycemia following ACS. ACS was associated with insulin resistance and increased levels of specific insulin, proinsulin, and high proinsulin-to-insulin ratios.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted July 15, 2005.
    • Received June 24, 2005.
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