Key role of postchallenge hyperglycemia for the presence and extent of coronary atherosclerosis: An angiographic study

doi:10.1016/j.atherosclerosis.2007.11.020

Atherosclerosis

Volume 199, Issue 2, August 2008, Pages 317-322

https://doi.org/10.1016/j.atherosclerosis.2007.11.020 Get rights and content

Abstract

Background

The associations between impaired glucose tolerance (IGT) and postchallenge diabetes with the presence and extent of angiographically characterized coronary atherosclerosis are unclear.

Materials and methods

We enrolled 1040 consecutive Caucasian patients undergoing coronary angiography for the evaluation of coronary artery disease (CAD). An oral 75-g glucose tolerance test was performed in patients without previously diagnosed diabetes.

Results

From our patients, 394 had normal glucose tolerance (NGT), 190 impaired glucose tolerance (IGT), 90 isolated postchallenge diabetes (postchallenge glucose ≥200 mg/dl), and 366 type 2 diabetes previously established or newly diagnosed on the basis of fasting glucose (conventional diabetes). Coronary atherosclerosis was more frequent in patients with IGT, isolated postchallenge diabetes, or conventional diabetes when compared to NGT subjects (87.9, 95.6, 89.1 versus 80.7%; p = 0.030, 0.001, 0.043, respectively). The prevalence of significant coronary stenoses ≥50%, compared to NGT subjects (57.4%), was similar in IGT patients (59.5%; p = 0.628), but significantly higher in patients with isolated postchallenge diabetes (77.8%; p = 0.001) or conventional diabetes (68.0%; p = 0.002). Also the number of significant stenoses compared to NGT subjects was similar in IGT patients, but significantly higher in those with isolated postchallenge or conventional diabetes. These results were confirmed after multivariate adjustment.

Conclusions

Abnormal glucose tolerance is strongly and independently associated with angiographically characterized coronary atherosclerosis. In IGT, non-significant coronary atherosclerosis is more frequent than in NGT; the prevalence and number of significant stenoses increases when postchallenge diabetes evolves.

Introduction

Type 2 diabetes (T2DM) strongly increases the risk of cardiovascular events by a factor of two to four [1], [2]. Overt type 2 diabetes typically is preceded by impaired glucose tolerance (IGT) [3]. Prospective studies [4], [5] indicate that among patients with non-diabetic fasting glucose an abnormal glucose tolerance is associated with an increased cardiovascular risk, and that 2-h glucose during an oral glucose tolerance test (oGTT) is a better predictor of cardiovascular disease than fasting glucose. Over a shorter period of follow-up, a recent report from the Euro Heart Survey failed to show an increased risk of mortality and vascular events among CAD patients with IGT [6].

Myocardial infarction, a frequently applied endpoint in clinical studies, does not optimally reflect the atherogenicity of metabolic parameters. It is the last step in the development of atherothrombotic coronary artery disease (CAD), and thrombogenic factors ultimately determine whether or not infarction occurs [7], [8]. By coronary angiography, to the opposite, preferentially atherosclerosis is assessed. Therefore, it appears important to also investigate the association of risk factors with angiographically determined coronary atherosclerosis.

The prevalence rates of previously undiagnosed T2DM and of IGT in angiographied coronary patients are high [9], [10], [11]. However, the angiographically determined coronary state of patients with IGT or postchallenge diabetes remains unclear. We therefore aimed at investigating the associations of abnormal glucose tolerance with the presence and with the extent of angiographically determined coronary atherosclerosis in a large cohort of angiographied coronary patients.

Section snippets

Materials and methods

We consecutively enrolled 1046 Caucasian patients who underwent coronary angiography for routine evaluation of suspected or established stable CAD at the Medical University of Graz and at the Academic Teaching Hospital Feldkirch between October 1999 and March 2005. The patients were referred for angiography solely on the basis of the clinical indication made by the referring physicians. Patients who had suffered myocardial infarctions or acute coronary syndromes within 3 months prior to the

Demographic and biochemical characteristics in categories of the glycemic state

Demographic data of our 1040 patients were characteristic for a cohort undergoing coronary angiography for the evaluation of CAD, with a mean age of 64 ± 10 years and a preponderance of male gender (64.0%).

From our patients, 394 (37.8%) had a normal glucose tolerance (NGT), 190 (18.3%) an impaired glucose tolerance (IGT), 90 (8.7%) T2DM newly diagnosed solely on the basis of elevated postchallenge glucose in the oGTT (isolated postchallenge diabetes), and 366 (35.2%) T2DM previously established

Discussion

From our results, we conclude that abnormal glucose tolerance is strongly, significantly and independently associated with angiographically characterized coronary atherosclerosis. A gradual pattern of association emerges: at the threshold between NGT and IGT, non-significant lesions become more frequent. As soon as postchallenge diabetes is manifest, the prevalence of significant stenoses increases significantly, and at the same threshold, the extent of CAD (i.e. the number of significant

Acknowledgements

The VIVIT institute thanks Dr. Egmond Frommelt and the Innovationsstiftung of the Liechtenstein Global Trust (LGT) Bank (Bendern, Liechtenstein), Dr. Karl Josef Hier, Peter Goop Stiftung (Vaduz, Liechtenstein), Gabriela Dür and the Vorarlberger Landesregierung (Bregenz, Austria), as well as the Fachhochschule Dornbirn (Dornbirn, Austria) for providing us with generous research grants. We are grateful to Franz Rauch and the Vorarlberger Industriellenvereinigung (Bregenz, Austria), to Dr. Peter

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Type-2 diabetes mellitus (DM) is strongly associated with coronary artery disease (CAD) and increased risk of vascular events.1–3 DM accelerates CAD progression to a more severe form of the disease in patients with pre-existing CAD4,5 despite standard diabetic interventions.6 The progression of atherosclerosis leads to repeat revascularization in > 50% of diabetic patients during a 10-year follow-up.5
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Our data showed that in women with premature CAD, but not in men, DM may have a significant role in emerging revascularization during a mean follow-up of 5 years.
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Key role of postchallenge hyperglycemia for the presence and extent of coronary atherosclerosis: An angiographic study

Abstract

Background

Materials and methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Demographic and biochemical characteristics in categories of the glycemic state

Discussion

Acknowledgements

Atherosclerosis

Am Heart J

Am J Cardiol

Atherosclerosis

Am Heart J

Diabetes Res Clin Pract

Diabetes and cardiovascular disease. The Framingham study

JAMA

Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial

Diabetes Care

Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study

Diabetes Care

Diabetes known or newly detected, but not impaired glucose regulation, has a negative influence on 1-year outcome in patients with coronary artery disease: a report from the Euro Heart Survey on diabetes and the heart

Eur Heart J

The pathogenesis of coronary artery disease and the acute coronary syndromes (1)

N Engl J Med

The pathogenesis of coronary artery disease and the acute coronary syndromes (2)

N Engl J Med