Abstract 18064: Effect of Fluctuations in Glucose Levels on Vascular Endothelial Dysfunction and Clinical Outcomes in Coronary Artery Disease (CAD) Patients Without Diabetes Mellitus (DM)

Abstract

Background: Fluctuations in glucose levels give rise to inflammation and endothelial dysfunction by increasing oxidative stress. Mean amplitude of glycemic excursions (MAGE) is commonly used as a degree of fluctuations in glucose level, and play a significant role in vascular endothelial dysfunction in diabetes mellitus (DM) patients, but not so clear in non-DM patients. Vascular endothelial dysfunction is associated with an increased risk of cardiovascular events. Thus, we examined the impact of MAGE on vascular endothelial dysfunction and clinical outcomes in non-DM patients with CAD. Methods: We analyzed 48 CAD patients following percutaneous coronary intervention (PCI) during 12 months, and assessed the relation among MAGE measured by continuous glucose monitoring (CGM), the level of high-sensitivity CRP (hs-CRP), and reactive hyperemia index (RHI) measured from RH-PAT (reactive hyperemia peripheral arterial tonometry). Cardiovascular events were cardiovascular death, myocardial infarction, unstable angina, and revascularization. Results: In clinical characteristics, HbA1c and MAGE were 5.96±0.40% and 62.5±32.6mg/dl. MAGE correlated with hs-CRP (r=0.426; P=0.003) and RHI (r=–0.403; P=0.007), but not correlated with body mass index (BMI), HbA1c, LDL cholesterol, and systolic blood pressures. In short, high glycemic excursions (high MAGE) is associated with high inflammation (high level of hs-CRP) and vascular endothelial dysfunction (low RHI). When patients were classified into MAGE<65mg/dl (normal glycemic excursions) and MAGE>65mg/dl (high glycemic excursions), group of MAGE>65mg/dl showed significant higher hs-CRP (0.05±0.03 vs 0.15±0.15mg/dl, P<0.001) and lower RHI (1.98±0.45 vs 1.74±0.38, P=0.003) compared with group of MAGE<65mg/dl. Multivariate analysis for clinical outcomes identified high MAGE as predictive factors (OR4.7, P=0.032). In ROC curve, MAGE is predictive index for cardiovascular events (AUC 0.533, P=0.01). Conclusions: Fluctuations in glucose levels are associated with inflammation, endothelial dysfunction, and cardiovascular events. And, MAGE may be good predictive index for cardiovascular events in CAD patients without DM.