Glycosylated hemoglobin is associated with decreased endothelial function, high inflammatory response, and adverse clinical outcome in non-diabetic STEMI patients

Author(s):Show less -

Moura, Filipe A. ^[1] ; Figueiredo, Valeria N. ^[1] ; Teles, Bruna S. B. S. ^[2] ; Barbosa, Meyrianne A. ^[2] ; Pereira, Lara R. ^[2] ; Costa, Ana P. R. ^[2] ; Carvalho, Luiz Sergio F. ^[1] ; Cintra, Riobaldo M. R. ^[1] ; Almeida, Osorio L. R. ^[3] ; Quinaglia e Silva, Jose C. ^[3] ; Nadruz Junior, Wilson ^[1] ; Sposito, Andrei C. ^[1] ; Study, Brasilia Heart

Affiliation

^[1] State Univ Campinas Med Sch Unicamp, BR-13084971 Campinas, SP - Brazil

^[2] Univ Brasilia, Med Sch UnB, Brasilia, DF - Brazil

^[3] Hosp Base Dist Fed, Brasilia, DF - Brazil

• Document type: Journal article
• Source: ATHEROSCLEROSIS; v. 243, n. 1, p. 124-130, NOV 2015.
• Web of Science Citations: 11

Abstract

Objective: Chronic dysglycemia was recently identified as a predictor for adverse outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention. Data for non-diabetic patients who underwent thrombolysis is scarce. In this context, we aimed to study the effect of HbA1c on cardiovascular outcome after STEMI. Methods: A prospective cohort of 326 non-diabetic STEMI individuals was used for the analyses. We measured plasma glucose, hemoglobin A(1c) {[}HbA(1c)], lipid profile, C-reactive protein (CRP), and nitrate/nitrite (NOx) upon admission and five days after STEMI (D5). Flow-mediated dilation (FMD) was performed 30 days after STEMI. During clinical follow-up, we assessed patients for incident diabetes (progression to HbA1c >= 6.5%) and major adverse cardiac events (MACE), defined as a composite of fatal and non-fatal MI, sudden cardiac death, and angina requiring hospitalization. Results: Using ROC-curve analysis, a 5.8% HbA1c best predicted MACE with a sensitivity of 75% and specificity of 53% (AUC 0.673, p = 0.001). Patients were categorized as high HbA1c if >= 5.8% and low HbA1c if <5.8%. Compared with patients with low HbA1c, those with high HbA1c presented with 20% higher CRP-D5 (p = 0.009) and 19% higher Delta CRP (p = 0.01), a 32% decrease in Delta NOx (p < 0.001), and 33% lower FMD (p < 0.001). After a median follow-up of 1.9 (1.1-2.8) years, patients with high HbA(1c) had more incident diabetes (HR 2.3 95% CI 1.01-5.2; p = 0.048) and MACE (HR 3.32 95% CI 1.09-10.03; p = 0.03). Conclusion: Non-diabetic STEMI patients with high HbA1c present with decreased endothelial function and increased inflammatory response and long-term risk of MACE. (C) 2015 Elsevier Ireland Ltd. All rights reserved. (AU)

• FAPESP's process: 12/18044-1 - Effect of niacin on HDL Cholesterol and endothelial function in patients with low HDL Cholesterol levels with or without hypertriglyceridaemia.
• Grantee: Valéria Nasser Figueiredo
• Support Opportunities: Scholarships in Brazil - Post-Doctoral