Study Associates Chronic Dysglycemia (HbA1c ≥ 5.8%) with Inflammation, Endothelial Dysfunction, and Higher Cardiovascular Event Rates post STEMI

Many prevention specialists believe that we are not diagnosing diabetes early enough if we wait for hemoglobin A1c (HbA1c) levels to reach ≥ 6.5%.  Filepe Moura and colleagues sought to find out if there was a relationship between HbA1c  levels in non-diabetic ST-elevation myocardial infarction (STEMI) patients and recurrent cardiac events.  Data, from a prospective cohort of 326 patients, reviewed by the investigators included plasma glucose, HbA1c, nitrate/nitrite (NOx), and C-reactive protein (CRP).  At 30 days post-STEMI, flow-mediated dilation (FMD) was also measured.  Incidence of progression to diabetes (HbA1c levels  ≥ 6.5%) and major adverse cardiac events (MACE) defined as angina requiring hospitalization, fatal and non-fatal myocardial infarction, and sudden cardiac death was recorded during the follow-up period.  A  ROC-analysis revealed that a HbA1c  of 5.8% best predicted MACE.  Patients were divided into two groups based on HbA1c levels : those with ≥ 5.8% as high HbA1c and those with levels <5.8% as low HbA1c.  Patients who fell into the high group also had significantly higher CRP and NOx levels and a 33% lower FMD.  The authors found markers of increased inflammation and endothelial dysfunction in these patients who had HbA1c  ≥ 5.8% and concluded that this group of non-diabetic STEMI patients also had a higher long-term risk of MACE.

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