Association between 1,5-anhydro-D-sorbitol, Insulin, and Incretins in Patients with Pre-diabetes and ST-elevation Myocardial Infarction

Abstract

BACKGROUND: Prediabetes itself could be an independent predictor of such adverse cardiovascular events as myocardial infarction and ischemic stroke. Since prediabetes is linked with hyperinsulinism it could also cause fluctuations of incretins concentration. Another significant fact related to prediabetes is glycemic variability. The impact of these factors on prediabetes and acute myocardial infarction is a promising phenomenon to study.
 AIM: The study aims to estimate insulin, incretins, and glycemic variability in patients with impaired carbohydrate metabolism and acute myocardial infarction
 METHODS: The 255 prediabetes patients participated in the observational case-control study. The first group included 85 patients hospitalized for STEMI. The second group included 170 patients without STEMI. Insulin and incretins were measured using a multiplex immunological assay with XMap technology on Bioplex 3D. The high-performance liquid chromatography with mass spectrometry was used to evaluate 1,5-AG concentration. The binary logistic regression was performed to evaluate the association between studying parameters and STEMI. 
 RESULTS: The insulin secretion parameters showed higher insulin and C-peptide level in patients with STEMI. A similar trend was noted for the HOMA-IR index. Among incretin, we revealed a higher level of glucagon and reduced GLP-1 in patients with STEMI. The of 1,5-AG in STEMI patients was significantly lower than in non-STEMI patients. The logistic regression model shows that a lower plasma concentration of 1,5-AG increases the odds of STEMI in patients with prediabetes [OR 2.304 (95% CI 1.980–2.973), p = 0.018]. Reduced GLP-1 concentration also increased the odds of STEMI [OR 1.775 (95% CI 1.460-1.990), p = 0.001].
 CONCLUSION: We discovered the association between 1,5-AG, GLP-1, and STEMI in patients with prediabetes. It is designating their potential role as cardiovascular risk markers in non-diabetic patients with impaired glucose metabolism.