Increased glycemic variability predicts MACE in diabetes patients with ACS
medwireNews: A high degree of glycemic variability (GV) is associated with a significantly increased risk for midterm major cardiovascular events (MACE) in patients with diabetes and acute coronary syndrome (ACS), French researchers report.
Based on these findings, Bogdan Catargi, from Bordeaux University, and co-authors say that a high GV should “alert physicians in charge of patients to their potential cardiovascular risk.”
During a mean follow-up of 16.9 months, 27.2% of 327 consecutive patients with diabetes and ACS experienced new-onset MACE following initial admission to an intensive cardiac care unit.
Of these, 10.7% had new-onset myocardial infarction, 9.2% were hospitalized for acute heart failure, and 7.3% died of cardiac causes.
During the initial hospital admission (median duration 4 days), patients had their blood glucose measured on a discontinuous basis, which allowed the researchers to calculate GV using the standard deviation of glycemia.
Mean GV was 2.5 mmol/L, and the team notes that diabetes and dyslipidemia were generally well controlled among the patients, with mean glycated hemoglobin and low-density lipoprotein cholesterol levels of 7.6% and 2.7 mmol/L, respectively.
Catargi and co-investigators found that patients with a GV level above 2.7 mmol/L – the optimal cutoff derived from receiver operating characteristic curve analysis – had a significantly higher incidence of each individual MACE component, as well as MACE overall, than patients with a lower level of GV.
In line with this, patients with a GV of more than 2.70 mmol/L were a significant 2.21 times more likely to develop MACE during follow-up than those with lower GV, making GV the strongest independent predictor of MACE in this cohort.
Other variables significantly associated with MACE were a SYNTAX score of more than 34, at an odds ratio (OR) of 1.88, and a left ventricular ejection fraction of less than 40%, at an OR of 1.71.
Writing in Diabetes Care, Catargi et al say that additional “prospective trials are needed to consider short-term GV as an independent risk factor for diabetic complications.”
They add: “Whether correction of high short-term GV can reduce the occurrence of MACE is still an unresolved question.”
Nonetheless, the authors conclude that their “study emphasizes that a high GV should probably be avoided in patients with diabetes and ACS.”
By Laura Cowen
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