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      The Prognostic Value of Fasting Plasma Glucose, Two-Hour Postload Glucose, and HbA 1c in Patients With Coronary Artery Disease: A Report From EUROASPIRE IV : A Survey From the European Society of Cardiology

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          Abstract

          OBJECTIVE

          Three tests are recommended for identifying dysglycemia: fasting glucose (FPG), 2-h postload glucose (2h-PG) from an oral glucose tolerance test (OGTT), and glycated hemoglobin A 1c (HbA 1c). This study explored the prognostic value of these screening tests in patients with coronary artery disease (CAD).

          RESEARCH DESIGN AND METHODS

          FPG, 2h-PG, and HbA 1c were used to screen 4,004 CAD patients without a history of diabetes (age 18–80 years) for dysglycemia. The prognostic value of these tests was studied after 2 years of follow-up. The primary end point included cardiovascular mortality, nonfatal myocardial infarction, stroke, or hospitalization for heart failure and a secondary end point of incident diabetes.

          RESULTS

          Complete information including all three glycemic parameters was available in 3,775 patients (94.3%), of whom 246 (6.5%) experienced the primary end point. Neither FPG nor HbA 1c predicted the primary outcome, whereas the 2h-PG, dichotomized as <7.8 vs. ≥7.8 mmol/L, was a significant predictor (hazard ratio 1.38, 95% CI 1.07–1.78; P = 0.01). During follow-up, diabetes developed in 78 of the 2,609 patients (3.0%) without diabetes at baseline. An FPG between 6.1 and 6.9 mmol/L did not predict incident diabetes, whereas HbA 1c 5.7–6.5% and 2h-PG 7.8–11.0 mmol/L were both significant independent predictors.

          CONCLUSIONS

          The 2h-PG, in contrast to FPG and HbA 1c, provides significant prognostic information regarding cardiovascular events in patients with CAD. Furthermore, elevated 2h-PG and HbA 1c are significant prognostic indicators of an increased risk of incident diabetes.

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          Most cited references21

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          Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I.

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            Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria.

            (2001)
            New diagnostic criteria for diabetes based on fasting blood glucose (FBG) level were approved by the American Diabetes Association. The impact of using FBG only has not been evaluated thoroughly. The fasting and the 2-hour glucose (2h-BG) criteria were compared with regard to the prediction of mortality. Existing baseline data on glucose level at fasting and 2 hours after a 75-g oral glucose tolerance test from 10 prospective European cohort studies including 15 388 men and 7126 women aged 30 to 89 years, with a median follow-up of 8.8 years, were analyzed. Hazards ratios for death from all causes, cardiovascular disease, coronary heart disease, and stroke were estimated. Multivariate Cox regression analyses showed that the inclusion of FBG did not add significant information on the prediction of 2h-BG alone (P>.10 for various causes), whereas the addition of 2h-BG to FBG criteria significantly improved the prediction (P<.001 for all causes and P<.005 for cardiovascular disease). In a model including FBG and 2h-BG simultaneously, hazards ratios (95% confidence intervals) in subjects with diabetes on 2h-BG were 1.73 (1.45-2.06) for all causes, 1.40 (1.02-1.92) for cardiovascular disease, 1.56 (1.03-2.36) for coronary heart disease, and 1.29 (0.66-2.54) for stroke mortality, compared with the normal 2h-BG group. Compared with the normal FBG group, the corresponding hazards ratios in subjects with diabetes on FBG were 1.21 (1.01-1.44), 1.20 (0.88-1.64), 1.09 (0.71-1.67), and 1.64 (0.88-3.07), respectively. The largest number of excess deaths was observed in subjects who had impaired glucose tolerance but normal FBG levels. The 2h-BG is a better predictor of deaths from all causes and cardiovascular disease than is FBG.
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              Waist circumference as a measure for indicating need for weight management.

              To test the hypothesis that a single measurement, waist circumference, might be used to identify people at health risk both from being overweight and from having a central fat distribution. A community derived random sample of men and women and a second, validation sample. North Glasgow. 904 men and 1014 women (first sample); 86 men and 202 women (validation sample). Waist circumference, body mass index, waist:hip ratio. Waist circumference > or = 94 cm for men and > or = 80 cm for women identified subjects with high body mass index (> or = 25 kg/m2) and those with lower body mass index but high waist:hip ratio (> or = 0.95 for men, > or = 0.80 women) with a sensitivity of > 96% and specificity > 97.5%. Waist circumference > or = 102 cm for men or > or = 88 cm for women identified subjects with body mass index > or = 30 and those with lower body mass index but high waist:hip ratio with a sensitivity of > 96% and specificity > 98%, with only about 2% of the sample being misclassified. Waist circumference could be used in health promotion programmes to identify individuals who should seek and be offered weight management. Men with waist circumference > or = 94 cm and women with waist circumference > or = 80 cm should gain no further weight; men with waist circumference > or = 102 cm and women with waist circumference > or = 88 cm should reduce their weight.
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                Author and article information

                Journal
                Diabetes Care
                Diabetes Care
                diacare
                dcare
                Diabetes Care
                Diabetes Care
                American Diabetes Association
                0149-5992
                1935-5548
                September 2017
                21 June 2017
                : 40
                : 9
                : 1233-1240
                Affiliations
                [1] 1Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
                [2] 2Department of Public Health, Ghent University, Ghent, Belgium
                [3] 3Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, U.K.
                [4] 4Forschergruppe Diabetes e.V., Munich, Germany
                [5] 5Disease Risk Unit, National Institute for Health and Welfare, Helsinki, Finland
                [6] 6Department of Neurosciences and Preventive Medicine, Danube-University Krems, Krems, Austria
                [7] 7Dasman Diabetes Institute, Dasman, Kuwait
                [8] 8Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
                Author notes
                Corresponding author: Bahira Shahim, bahirashahim@ 123456gmail.com .
                Author information
                http://orcid.org/0000-0001-5688-6101
                Article
                0245
                10.2337/dc17-0245
                5566283
                28637653
                4e34d86c-2d1f-485e-927b-7dd1152da7e2
                © 2017 by the American Diabetes Association.

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.

                History
                : 1 February 2017
                : 26 May 2017
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 36, Pages: 8
                Funding
                Funded by: European Society of Cardiology, DOI http://dx.doi.org/10.13039/501100000860;
                Funded by: Swedish Heart and Lung Foundation, DOI http://dx.doi.org/;
                Categories
                0403
                Cardiovascular and Metabolic Risk

                Endocrinology & Diabetes
                Endocrinology & Diabetes

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