Cardiovascular Events In Nondiabetic Patients Research Articles

The Prognostic Value of the Triglyceride-Glucose Index in Forecasting Ten-Year Major Adverse Cardiovascular Events in Non-Diabetic Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

This study aimed to explore the association between the triglyceride-glucose (TyG) index and major adverse cardiovascular events (MACE) over a ten-year period in non-diabetic patients with acute myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI). We included 375 consecutive non-diabetic patients presenting with acute MI who underwent primary PCI. The TyG index was calculated and patients were divided based on a cut-off value of ≥ 8.84 into high and low TyG index groups. The incidence of MACE, including all-cause mortality, target vessel revascularization, reinfarction, and rehospitalization for heart failure, was assessed over 10 years. Over the next 10 years, patients who underwent PCI for acute MI experienced a significantly higher incidence of MACE in the group with a high TyG index (≥ 8.84) (P = 0.004). Multivariable analysis revealed that the TyG index independently predicted MACE in these patients [odds ratio = 1.64; 95% confidence interval (CI): 1.22-2.21; P = 0.002]. Analysis of the receiver operating characteristic curve indicated that the TyG index effectively predicted MACE in patients with acute MI following PCI, with an area under the curve of 0.562 (95% CI: 0.503-0.621; P = 0.038). This study established a correlation between high TyG index levels and an elevated risk of MACE in non-diabetic patients with acute MI. The findings suggest that the TyG index could be a reliable indicator of clinical outcomes for non-diabetic acute MI patients undergoing PCI.

Relation between Left Ventricular Wall Stress after Primary Percutaneous Coronary Intervention and Adverse Cardiovascular Events in Non-Diabetic Patients with Acute Anterior ST-Segment Elevation Myocardial Infarction

Relation between Left Ventricular Wall Stress after Primary Percutaneous Coronary Intervention and Adverse Cardiovascular Events in Non-Diabetic Patients with Acute Anterior ST-Segment Elevation Myocardial Infarction

Triglyceride-glucose index in the prediction of adverse cardiovascular events in patients without diabetes mellitus after coronary artery bypass grafting: a multicenter retrospective cohort study

BackgroundThe triglyceride-glucose (TyG) index has been evaluated as a reliable surrogate for insulin resistance (IR) and has been proven to be a predictor of poor outcomes in patients with cardiovascular diseases. However, data are lacking on the relationship of the TyG index with prognosis in nondiabetic patients who underwent coronary artery bypass grafting (CABG). Thus, the purpose of our current study was to investigate the potential value of the TyG index as a prognostic indicator in patients without diabetes mellitus (DM) after CABG.MethodsThis multicenter, retrospective cohort study involving 830 nondiabetic patients after CABG from 3 tertiary public hospitals from 2014 to 2018. Kaplan–Meier survival curve analysis was conducted followed by the log-rank test. Cox proportional hazards regression models were used to explore the association between the TyG index and major adverse cardiovascular events (MACEs). The incremental predictive power of the TyG index was evaluated with C-statistics, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).ResultsAn incrementally higher TyG index was associated with an increasingly higher cumulative incidence of MACEs (log-rank test, p < 0.001). The hazard ratio (95% CI) of MACEs was 2.22 (1.46–3.38) in tertile 3 of the TyG index and 1.38 (1.18–1.62) per SD increase in the TyG index. The addition of the TyG index yielded a significant improvement in the global performance of the baseline model [C-statistic increased from 0.656 to 0.680, p < 0.001; continuous NRI (95% CI) 0.269 (0.100–0.438), p = 0.002; IDI (95% CI) 0.014 (0.003–0.025), p = 0.014].ConclusionsThe TyG index may be an independent factor for predicting adverse cardiovascular events in nondiabetic patients after CABG.

Effects of the Mean Amplitude of Glycemic Excursions and Vascular Endothelial Dysfunction on Cardiovascular Events in Nondiabetic Patients With Coronary Artery Disease.

BackgroundMean amplitude of glycemic excursion (MAGE) is commonly used to gauge the degree of glucose level fluctuations. MAGE plays a significant role in vascular endothelial dysfunction and cardiovascular events in patients with diabetes mellitus (DM), but its significance is not clear in non‐DM patients. Thus, we examined the impact of MAGE and vascular endothelial dysfunction on clinical outcomes in non‐DM patients with coronary artery disease.Methods and ResultsWe followed non‐DM patients (n=65) for 12 months who underwent percutaneous coronary intervention and assessed the relationship among MAGE, reactive hyperemia index (RHI) measured by reactive hyperemia peripheral arterial tonometry as endothelial function, and cardiovascular events. Cardiovascular events analyzed were cardiovascular death, myocardial infarction, unstable angina, and revascularizations. Compared with patients with MAGE <65 mg/dL (normal glycemic excursions), the group with MAGE ≥65 mg/dL (high glycemic excursions) had significantly higher high‐sensitivity C‐reactive protein (0.10±0.11 mg/dL versus 0.18±0.13 mg/dL, P=0.006) and lower RHI (0.64±0.21 versus 0.51±0.22, P=0.035). The multivariable analysis identified high MAGE and low RHI (≤0.56) as risk factors associated with cardiovascular events (hazard ratio, 5.6; 95% RI, 1.72–18.4 [P=0.004] versus hazard ratio, 4.5; 95% RI, 1.37–14.9 [P=0.013]). When the prognosis was classified by combination with MAGE and RHI, the incidence of cardiovascular events was 46.7% (high MAGE+low RHI), 26.7% (high MAGE+high RHI), 20.0% (low MAGE+low RHI), and 6.6% (low MAGE+high RHI) in descending order (P=0.014). Receiver operating characteristic curve analysis revealed that MAGE, RHI, and MAGE+RHI were each associated with cardiovascular events (area under the curve 0.780, 0.727, and 0.796, respectively).Conclusions MAGE was associated with cardiovascular events in non‐DM patients with coronary artery disease. Furthermore, the combination with MAGE and RHI was useful for further subdivision of the risk of cardiovascular events.

Insulin resistance is associated with new-onset cardiovascular events in nondiabetic patients undergoing peritoneal dialysis

BackgroundChronic exposure to high glucose-containing peritoneal dialysis solution and consequent abdominal obesity are potential sources of insulin resistance in patients requiring prevalent peritoneal dialysis. The aim of this study was to elucidate the prognostic values of insulin resistance on new-onset cardiovascular events in nondiabetic patients undergoing prevalent peritoneal dialysis. MethodsA total of 201 nondiabetic patients undergoing prevalent peritoneal dialysis were recruited. Insulin resistance was assessed by homeostatic model assessment of insulin resistance (HOMA-IR). The primary outcome was new-onset cardiovascular events during the follow-up period. Cox proportional hazard analysis was performed to ascertain the independent prognostic value of HOMA-IR for the primary outcome. ResultsThe mean age was 53.1 years and male was 49.3% (n=99). The mean HOMA-IR was 2.6±2.1. In multivariate linear regression, body mass index (β=0.169, P=0.011), triglyceride level (β=0.331, P<0.001), and previous cardiovascular diseases (β=0.137, P=0.029) were still significantly associated with HOMA-IR. During a mean follow-up duration of 36.8±16.2 months, the primary outcome was observed in 36 patients (17.9%). When patients were divided into tertiles according to HOMA-IR, the highest tertile group showed a significantly higher incidence rate for new-onset cardiovascular events compared to the lower two tertile groups (P=0.029). Furthermore, multivariate Cox analysis revealed that HOMA-IR was an independent predictor of the primary outcome (hazard ratio=1.18, 95% confidence interval=1.03–1.35, P=0.014). ConclusionInsulin resistance measured by HOMA-IR was an independent risk factor for new-onset cardiovascular events in nondiabetic patients undergoing prevalent peritoneal dialysis.

Insulin resistance negatively affects long-term outcome in non-diabetic patients with coronary artery disease after therapies to reduce atherosclerotic risk factors

BackgroundInsulin resistance (IR) is a predictor of cardiovascular (CV) events even before the onset of diabetes. However, it is unclear whether changes in IR after a reduction of atherosclerotic burden may affect long-term outcome in patients with coronary artery disease (CAD). This study examined whether changes in IR after therapy to reduce atherosclerotic risk factors provides prognostic information on future CV events in non-diabetic patients with CAD. Methods and resultsThis study enrolled 175 non-diabetic patients with newly diagnosed CAD and IR. IR was defined as the homeostasis model assessment of IR (HOMA-IR)≧2.5. Evaluation of HOMA-IR was repeated at entry (1st test) and 6 months after individualized, optimized therapy including medications and lifestyle changes (2nd test). After the 2nd test, all patients were prospectively followed-up for 3 years or until the occurrence of one of the following events: CV death, nonfatal myocardial infarction, unstable angina requiring coronary revascularization, or ischemic stroke. IR was improved (HOMA-IR<2.5) after 6 months in 71 (41%) patients, whereas IR persisted in 104 (59%) patients. During the follow-up period, events occurred in 21 (20%) of the 104 patients with persistent IR and 3 (4%) of the 71 patients with improved IR (p<0.01). In multivariate stepwise Cox proportional hazards analysis, persistent IR was an independent predictor of future CV events (HR 4.8, 95% CI 1.4–11.2, p<0.01). ConclusionsThe presence of IR despite optimized therapies to reduce atherosclerotic risk factors represents an adverse outcome predictor in non-diabetic patients with CAD.

Glycosylated hemoglobin levels are associated with cardiovascular events in nondiabetic peritoneal dialysis patients

High glycosylated hemoglobin (HbA1c) levels are recognized as a risk factor for cardiovascular disease in the diabetic dialysis population. However, it is not known whether this also applies to nondiabetic dialysis patients. We prospectively investigated the association between HbA1c levels and new cardiovascular events in nondiabetic patients treated with peritoneal dialysis. Eighty nondiabetic patients who had been on peritoneal dialysis treatment were prospectively followed for 5 years. HbA1c levels were measured at baseline and every 3 months. Fatal and nonfatal cardiovascular events were assessed during the follow-up. Mean age was 48.5 ± 15.2 years; 51% were male. Baseline HbA1c level was 5.46% ± 0.41% (range 4.6%-6.3%). Mean HbA1c was 5.44% ± 0.31% (range 4.8%-6.3%) during the study, and positively correlated with age and high-sensitivity C-reactive protein. Twenty fatal and nonfatal cardiovascular events were observed during a mean 41.8 ± 7.1 months of follow-up. Event-free survival was better in patients with HbA1c levels <5.45%, compared with that for those with HbA1c levels =5.45% (p=0.01). In crude Cox regression analysis, an increase in HbA1c level of 0.1% was associated with a 1.22-fold increase in new cardiovascular events (p=0.007). In Cox analyses, HbA1c level was found as a significant predictor of cardiovascular events. HbA1c levels predict fatal and nonfatal cardiovascular events in nondiabetic peritoneal dialysis patients.

Plasma levels of soluble receptor for advanced glycation end products are associated with endothelial function and predict cardiovascular events in nondiabetic patients

We sought to test the hypothesis that decreased plasma soluble receptor for advanced glycation end products (sRAGE) levels were associated with endothelial dysfunction in nondiabetic patients. sRAGE, a C-truncated secretary isoform of the receptor protein, has been shown to neutralize vascular damage mediated by advanced glycation end products, and has been implicated in atherogenesis. However, the relation between plasma sRAGE level and endothelial function remains unclear. Plasma levels of sRAGE were examined in 180 nondiabetic participants with suspected coronary artery disease. Endothelial function was evaluated by endothelium-dependent flow-mediated vasodilation (FMD) of the brachial artery. The primary end point was the combined occurrence of major adverse cardiovascular events, including nonfatal myocardial infarction, revascularization with percutaneous coronary intervention or coronary artery bypass grafting, ischemic stroke, and cardiovascular death. All participants were divided into three groups according to the magnitude of FMD: group 1 (FMD <3%), group 2 (FMD >or=3 and <6%), group 3 (FMD >or=6%). The plasma levels of sRAGE were significantly decreased in group 1 compared with groups 2 and 3 (676+/-270, 820+/-357, and 1140+/-451 pg/ml; P<0.001). By multivariate analysis, it was shown that the plasma sRAGE level was an independent predictor of endothelium-dependent FMD (R = 0.46; P<0.001). After a 48-month follow-up period, there were 23 events (26%) in the lower sRAGE group(<or=median, 809 pg/ml) and 11 events (12%) in the higher sRAGE group (>809 pg/ml; P<0.05). By the Kaplan-Meier analysis, it was shown that enhanced plasma levels of sRAGE were associated with better major adverse cardiovascular event-free survival (P = 0.032). The results indicate that plasma sRAGE levels are positively associated with endothelial function and predict cardiovascular events in nondiabetic participants with suspected coronary artery disease, suggesting its pivotal role in atherothrombosis.

Differential impact of left ventricular mass and relative wall thickness on cardiovascular prognosis in diabetic and nondiabetic hypertensive subjects

Cardiovascular prognostic significance of relative wall thickness (RWT) in patients with diabetes has not been reported although concentric hypertrophy is common in diabetic patients. This study was conducted to test the hypothesis that the prognostic significance of different measures of left ventricular (LV) geometric change, principally LV mass index (LVMI) and RWT, would be different in diabetic patients compared with nondiabetic individuals among Japanese hypertensive subjects. Ambulatory blood pressure monitoring and echocardiography were performed in 400 uncomplicated hypertensive individuals at baseline, of whom 379 (157 with diabetes and 222 without diabetes; mean age 67.8 +/- 8.8 years) were successfully followed up for 63 +/- 26 months to document cardiovascular events. We dichotomized LVMI and RWT to the highest quartile vs other 3 quartiles for further categoric analyses in diabetic and nondiabetic patients. Fifty-three cardiovascular events occurred during the follow-up period. With Kaplan-Meier analysis, both diabetic and nondiabetic patients with the highest quartile of LVMI showed a significantly higher incidence of cardiovascular vents. However, the highest quartile of RWT was associated with cardiovascular events only in diabetic subjects. With Cox regression analyses controlling for age, sex, body mass index, serum creatinine, triglycerides, and clinic systolic blood pressure, RWT (per 0.01 change), but not LVMI, was associated with cardiovascular events in diabetic patients (relative risk: 1.06, 95% confidence interval 1.02-1.11; P = .008), whereas LVMI (g/m2), but not RWT, was associated with cardiovascular events in nondiabetic patients (relative risk: 1.02, 95% confidence interval 1.01-1.03; P = .005). In hypertensive subjects with type 2 diabetes mellitus, echocardiographic LV RWT is a predictor of cardiovascular events independent of LV mass and other confounders.

Risk Stratification and Prognostic Implication of Plasma Biomarkers in Nondiabetic Patients With Stable Coronary Artery Disease: The Role of High-Sensitivity C-Reactive Protein

To evaluate the implication of plasma biomarkers to future cardiovascular events in nondiabetic patients with stable coronary artery disease (CAD). Designs and settings: Prospective, follow-up study at a tertiary referral center. Patients and measurement: Serial plasma biomarkers including high-sensitivity C-reactive protein (hsCRP), homocysteine, soluble adhesion molecules, von Willebrand factor, and lipid profiles were determined before coronary angiograms in a series of nondiabetic CAD patients with stable angina. Among them, 75 consecutive patients who received coronary revascularization (48 coronary interventions and 27 coronary bypass surgeries) later and another 75 age- and gender-matched patients who preferred medical treatment were both enrolled. In patients of each group, major cardiovascular events including cardiac death, nonfatal myocardial infarction, new or repeated coronary revascularization, and hospitalization for unstable angina, stroke, or peripheral artery disease were prospectively followed up for at least 6 months.Patients were followed up to 40 months (median, 18 months). The incidences of major cardiovascular events were similar between the two groups. For patients with medical treatment, plasma levels of hsCRP, homocysteine, low-density lipoprotein, and the ratio of total cholesterol (TC) to high-density lipoprotein cholesterol (HDL-C) were significantly higher in those with cardiovascular events than those without. However, only hsCRP > 0.1 mg/dL (relative risk [RR], 2.78; 95% confidence interval [CI], 1.21 to 6.41; p = 0.016) and TC/HDL-C ratio > 4.8 (RR, 2.42; 95% CI, 1.04 to 5.65; p = 0.041) were independent predictors by multivariable analysis. For patients with revascularization, basal plasma hsCRP levels were higher in those with cardiovascular events than those without (p = 0.04). However, no biochemical markers could predict future major cardiovascular events in these patients.In nondiabetic patients with CAD, basal plasma hsCRP levels were increased with future cardiovascular events regardless of different treatment strategies. Both plasma hsCRP level and TC/HDL-C ratio independently predict future cardiovascular events, confirming the role of plasma biomarkers in clinical risk stratification especially in patients with medical treatment.

Does microalbuminuria predict cardiovascular events in nondiabetic men with treated hypertension?

The aim of this study was to investigate the predictive value of microalbuminuria (overnight urinary albumin excretion rate 17 to 100 mg/12 h) as a risk factor for future major cardiovascular events in nondiabetic patients with treated hypertension in a prospective study with follow-up time of 3.3 years. Overnight urinary albumin excretion was measured in 345 nondiabetic treated hypertensive men, aged 50 to 72 years, either with a serum cholesterol of > or = 6.5 mmol/L or smokers, or both. Cardiovascular morbidity was closely recorded during the follow-up period. At entry, microalbuminuria was found in 84 patients (24.3%) and 12 patients had macroalbuminuria (3.5%). During the follow-up period there were no differences in new cardiovascular events between patients with microalbuminuria and those with normoalbuminuria. However, an increase in the risk of future major cardiovascular events occurred in patients with urinary albumin excretion above 100 mg/12 h (macroalbuminuria). In a Cox regression analysis urinary albumin excretion was not associated with the incidence of future major cardiovascular events unless a more detailed approach was used, showing that this was the case for urinary albumin excretion above 100 mg/12 h (macroalbuminuria). Calculations with an alternative definition of microalbuminuria and mortality as end-point did not change the principal result. In conclusion, microalbuminuria does not seem to be a predictor of future mortality and cardiovascular morbidity in nondiabetic men with treated hypertension and at high risk of coronary heart disease. However, macroalbuminuria was associated with future major cardiovascular events in this group of patients.