The impact glycosylated hemoglobin level on admission plasma beta amyloid in patients with acute myocardial infarction

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by Regione Friuli Venezia Giulia (grant for the project “Lo scompenso cardiaco quale morbo di Alzheimer del cuore: opportunita ` diagnostiche e terapeutiche—HEARTzheimer”). Background A strong relationship exists between Diabetes Mellitus and Alzheimer’s disease (AD) and the most recent researches in order to underline this strong connection are talking about type 3 diabetes. Plasma beta amyloid (Aβ) has pro-atherosclerotic and pro-inflammatory traits and has been associated with AD, aging, atherosclerotic processes, depression and diabetes. Aim and Methods We aimed to study the levels of Aβ 40 in a large population of patients with acute myocardial infarction and to evaluate if any association exists with long-term glycemic control. Hemoglobin A1c, Aβ 40, Vitamin D, hs CRP and TNF alpha were measured at hospital admission. Results In this study were included 603 patients admitted for acute myocardial infarction; according to hemoglobin A1c (HbA1c level), patients were classified into three groups: group 1 including 181 patients without diabetes (HbA1C < 39 mmol/mol), group 2 with 303 patients with pre-diabetes (HbA1C 39-47 mmol/mol) and group 3 comprising 199 patients with diabetes mellitus (HbA1C ≥48 mmol/mol). The levels of Aβ 40 significantly increase through group 1 to group 3 (76.1 [48-116], Vs. 91.3 [53.3-132], Vs. 101.6 [62.6-146.5], respectively, p<0.05, Figure 1). Also the levels of inflammatory markers CRP and TNF alpha were significantly higher in the group 3 respect to the other two groups. Independent predictors of Aβ 40 levels at regression analysis were presence of diabetes mellitus (OR 12.4, CI 95% 3.2-21.6, p=0.008), Vitamin D levels (OR 0.43, CI 95% 0.09-0.78, p 0.012) and renal function (OR 33.6, 95%CI 28.7-38.5, p<0.0001). Conclusions A better glyco-metabolic control in patients with myocardial infarction may reduce the risk of low-grade inflammation and production of biomarkers such as Aβ 40, associated with worse outcome. Further studies are necessary to evaluate if Aβ 40 levels are associated with post-MI depression and therapeutic non-compliance who lead to worse outcome.