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PreDiabetes Is A Strong Predictor Of Mortality
posted 03/18/04

A nondiabetic patient admitted with acute myocardial infarction and an elevated fasting glucose level is at high risk of death within a month.

Diabetic patients are known to have a greater risk of death and adverse events after myocardial infarction than nondiabetics. Small, retrospective studies have suggested that hyperglycemia in nondiabetics is also predictive of death, but Mahmoud Suleiman, MD, from Rambam Medical Center in Haifa, Israel, told meeting attendees that there have not been any prospective studies.

In Dr. Suleiman and colleagues' prospective study, they enrolled 577 nondiabetic patients admitted with AMI to their institution's cardiac intensive care unit. Patients with a known history of diabetes were excluded from the study. Fasting blood glucose levels were measured within 24 hours of admission and periodically throughout follow-up.

The investigators divided patients into tertiles according to glucose values. The lowest tertile consisted of patients with glucose levels less than 97 mg/dL, glucose levels in the middle tertile ranged from 97 to 118 mg/dL, and patients in the upper tertile had glucose values higher than 118 mg/dL.

Six deaths (3% of the study group) occurred in the lowest tertile, 10 deaths (5%) in the middle tertile, and 37 deaths (19%) occurred in the upper tertile by the 30-day mark. Many of the deaths in the upper tertile occurred in the first few days after MI. "These were all cardiac deaths," Dr. Suleiman said.

Dr. Suleiman reminded the audience that the new normal cutoff value for a normal glucose value is 100 mg/dL. The threshold for diabetes is defined as greater than 126 mg/dL. The findings show that a glucose level below that threshold is still a strong predictor of mortality.

Patients in the upper tertile had a 30-day mortality rate that was 3.5 times higher than that of patients in the lowest tertile, Dr. Suleiman reported. Elevated fasting glucose level at admission was "a strong, independent predictor of death, even after adjusting for other risk factors," he said.

Fasting glucose should be measured at admission and repeatedly during follow-up to gauge risk, Dr. Suleiman advised.

Dr. Suleiman noted that, "We adjusted fairly aggressively for other risks, things such as age, gender, previous heart attack, the size of the heat attack. High glucose remained a very strong independent predictor [of 30-day mortality]."

"These findings add another piece to the puzzle about where we stand with diabetes, the metabolic syndrome, and cardiovascular disease," commented Luis Gruberg, MD, director of Clinical Research Invasive Cardiology at Rambam Medical Center. He was not involved in the study.

"Elevated glucose was equal to other traditional predictors of outcome, such as heart rate, in the acute MI patient," Dr. Gruberg noted. "When a patient presents with MI, we need to look at risk factors other than the classics, such as glucose."

"We are continuing to follow these patients beyond the acute phase," Dr. Suleiman said. "We have found that about 10% of the patients with elevated glucose levels were undiagnosed diabetics." Because the findings are preliminary, Dr. Suleiman does not yet recommend treating nondiabetic MI patients for elevated glucose levels.

Source: Diabetes In Control.com: ACC 53rd Annual Scientific Session: Session 827-2. Presented March 9, 2004.

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