Abstract
ObjectiveDiabetes mellitus type 2 (DM2) is a risk factor for coronary heart disease (CHD). While there is a clear correlation of fasting blood glucose (FBG) and 2 h post-challenge blood glucose values (2h-BG) with microvascular complications, the risk for CHD conferred by glucose dysregulation antecedent to DM2 is less clear. Therefore, we investigated associations of FBG and 2h-BG values with the prevalence of CHD assessed by coronary angiography as the most sensitive diagnostic tool.Research Design and MethodsCoronary angiography was performed in 1394 patients without known DM. Capillary blood glucose was analyzed before and 2 h after an oral glucose tolerance test. Associations between FBG as well as 2h-BG levels and the risk for CHD were assessed by logistic regression analysis.Results1064 (75%) of patients were diagnosed with CHD. 204 (15%) were diagnosed with so far unknown DM2, 274 (20%) with isolated impaired fasting glucose (IFG), 188 (13%) with isolated impaired glucose tolerance (IGT) and 282 (20%) with both, IGT and IFG. We found a continuous increase in the risk for CHD with fasting and post-challenge blood glucose values even in the subdiabetic range. This correlation did however not suggest clear cut-off values. The increase in risk for CHD reached statistical significance at FBG levels of > 120 mg/dl (Odds Ratio of 2.7 [1.3-5.6] and 2h-BG levels > 140 mg/dl (141-160 mg/dl OR 1.8 [1.1-2.9], which was however lost after adjusting for age, sex and BMI.ConclusionsIn our study population we found a continuous increased risk for CHD at fasting and 2h-BG levels in the sub-diabetic glucose range, but no clear cut-off values for cardiovascular risk.
Highlights
Diabetes mellitus type 2 (DM2) is a major risk factor for micro- and macrovascular complications like coronary heart disease (CHD)[1,2]
While there is a clear correlation of fasting blood glucose (FBG) and 2 h post-challenge blood glucose values (2h-BG) with microvascular diseases, the risk for CHD conferred by glucose dysregulation antecedent to DM2 is less clear
76% of the patients were diagnosed with CHD based on the lumen narrowing ≥50% diagnosed by coronary angiography
Summary
Diabetes mellitus type 2 (DM2) is a major risk factor for micro- and macrovascular complications like coronary heart disease (CHD)[1,2]. While there is a clear correlation of fasting blood glucose (FBG) and 2 h post-challenge blood glucose values (2h-BG) with microvascular diseases, the risk for CHD conferred by glucose dysregulation antecedent to DM2 is less clear. There are data from other studies reporting no correlation between FBG and mortality in the subdiabetic range[6]. The relation between IGT and cardiovascular risk remains unclear. The ARIC study for example found no association of IGT with cardiovascular risk over a 6.3 year follow-up period[12]. The largest meta-analysis in that area including 20 prospective studies and almost 100 000 individuals revealed an increased cardiovascular risk for people with IGT when analysing clinical cardiovascular events[13]
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