Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups

an analysis of 15,780 patients from the INTERHEART study

H. C. Gerstein, S. Islam, S. Anand, W. Almahmeed, A. Damasceno, A. Dans, Chim Lang, M. A. Luna, M. McQueen, S. Rangarajan, A. Rosengren, X. Wang, S. Yusuf

    Research output: Contribution to journalArticle

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    Abstract

    Aims/hypothesis Although diabetes is an established risk factor for myocardial infarction (MI), disease control may vary. HbA(1c) is a reliable index of ambient glucose levels and may provide more information on MI risk than diabetes status.

    Methods The relationship between HbA(1c) levels in MI patients and controls who participated in the 52 country INTERHEART study was analysed.

    Results In 15,780 participants with a HbA(1c) value (1,993 of whom had diabetes), the mean (SD) levels for HbA(1c) were 6.15% (1.10) in the 6,761 MI patients and 5.85% (0.80) in the control participants. After adjustment for age, sex and nine major MI risk factors (including diabetes), higher HbA(1c) fifths above the lowest fifth (HbA(1c) <5.4%) were associated with progressively higher OR of MI, with OR for the highest HbA(1c) fifth (>= 6.12%) being 1.55 (95% CI 1.37-1.75). When analysed as a continuous variable after adjustment for the same factors, every 1% higher HbA(1c) value was associated with 19% (95% CI 14-23) higher odds of MI, while every 0.5% higher HbA(1c) was associated with 9% higher odds of MI (95% CI 7-11). Concordant relationships were noted across subgroups, with a higher OR noted in younger people, patients without diabetes or hypertension, and those from some regions and ethnicities.

    Conclusions/interpretation The HbA(1c) value provides more information on MI odds than self-reported diabetes status or many other established risk factors. Every 1% increment independently predicts a 19% higher odds of MI after accounting for other MI risk factors including diabetes.

    Original languageEnglish
    Pages (from-to)2509-2517
    Number of pages9
    JournalDiabetologia
    Volume53
    Issue number12
    DOIs
    Publication statusPublished - 2010

    Keywords

    • Case-control
    • Diabetes
    • Dysglycaemia
    • Glycated haemoglobin
    • Myocardial infarction
    • ABNORMAL GLUCOSE REGULATION
    • CORONARY-ARTERY-DISEASE
    • CARDIOVASCULAR-DISEASE
    • 52 COUNTRIES
    • DIABETES-MELLITUS
    • HEMOGLOBIN A(1C)
    • HEART-FAILURE
    • BLOOD-GLUCOSE
    • MORTALITY
    • HOSPITALIZATION

    Cite this

    Gerstein, H. C. ; Islam, S. ; Anand, S. ; Almahmeed, W. ; Damasceno, A. ; Dans, A. ; Lang, Chim ; Luna, M. A. ; McQueen, M. ; Rangarajan, S. ; Rosengren, A. ; Wang, X. ; Yusuf, S. / Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups : an analysis of 15,780 patients from the INTERHEART study. In: Diabetologia. 2010 ; Vol. 53, No. 12. pp. 2509-2517.
    @article{0c2e5dac50714e11a6799393bc5fce39,
    title = "Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups: an analysis of 15,780 patients from the INTERHEART study",
    abstract = "Aims/hypothesis Although diabetes is an established risk factor for myocardial infarction (MI), disease control may vary. HbA(1c) is a reliable index of ambient glucose levels and may provide more information on MI risk than diabetes status.Methods The relationship between HbA(1c) levels in MI patients and controls who participated in the 52 country INTERHEART study was analysed.Results In 15,780 participants with a HbA(1c) value (1,993 of whom had diabetes), the mean (SD) levels for HbA(1c) were 6.15{\%} (1.10) in the 6,761 MI patients and 5.85{\%} (0.80) in the control participants. After adjustment for age, sex and nine major MI risk factors (including diabetes), higher HbA(1c) fifths above the lowest fifth (HbA(1c) <5.4{\%}) were associated with progressively higher OR of MI, with OR for the highest HbA(1c) fifth (>= 6.12{\%}) being 1.55 (95{\%} CI 1.37-1.75). When analysed as a continuous variable after adjustment for the same factors, every 1{\%} higher HbA(1c) value was associated with 19{\%} (95{\%} CI 14-23) higher odds of MI, while every 0.5{\%} higher HbA(1c) was associated with 9{\%} higher odds of MI (95{\%} CI 7-11). Concordant relationships were noted across subgroups, with a higher OR noted in younger people, patients without diabetes or hypertension, and those from some regions and ethnicities.Conclusions/interpretation The HbA(1c) value provides more information on MI odds than self-reported diabetes status or many other established risk factors. Every 1{\%} increment independently predicts a 19{\%} higher odds of MI after accounting for other MI risk factors including diabetes.",
    keywords = "Case-control, Diabetes, Dysglycaemia, Glycated haemoglobin, Myocardial infarction, ABNORMAL GLUCOSE REGULATION, CORONARY-ARTERY-DISEASE, CARDIOVASCULAR-DISEASE, 52 COUNTRIES, DIABETES-MELLITUS, HEMOGLOBIN A(1C), HEART-FAILURE, BLOOD-GLUCOSE, MORTALITY, HOSPITALIZATION",
    author = "Gerstein, {H. C.} and S. Islam and S. Anand and W. Almahmeed and A. Damasceno and A. Dans and Chim Lang and Luna, {M. A.} and M. McQueen and S. Rangarajan and A. Rosengren and X. Wang and S. Yusuf",
    year = "2010",
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    language = "English",
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    pages = "2509--2517",
    journal = "Diabetologia",
    issn = "0012-186X",
    publisher = "Springer Verlag",
    number = "12",

    }

    Gerstein, HC, Islam, S, Anand, S, Almahmeed, W, Damasceno, A, Dans, A, Lang, C, Luna, MA, McQueen, M, Rangarajan, S, Rosengren, A, Wang, X & Yusuf, S 2010, 'Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups: an analysis of 15,780 patients from the INTERHEART study', Diabetologia, vol. 53, no. 12, pp. 2509-2517. https://doi.org/10.1007/s00125-010-1871-0

    Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups : an analysis of 15,780 patients from the INTERHEART study. / Gerstein, H. C.; Islam, S.; Anand, S.; Almahmeed, W.; Damasceno, A.; Dans, A.; Lang, Chim; Luna, M. A.; McQueen, M.; Rangarajan, S.; Rosengren, A.; Wang, X.; Yusuf, S.

    In: Diabetologia, Vol. 53, No. 12, 2010, p. 2509-2517.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups

    T2 - an analysis of 15,780 patients from the INTERHEART study

    AU - Gerstein, H. C.

    AU - Islam, S.

    AU - Anand, S.

    AU - Almahmeed, W.

    AU - Damasceno, A.

    AU - Dans, A.

    AU - Lang, Chim

    AU - Luna, M. A.

    AU - McQueen, M.

    AU - Rangarajan, S.

    AU - Rosengren, A.

    AU - Wang, X.

    AU - Yusuf, S.

    PY - 2010

    Y1 - 2010

    N2 - Aims/hypothesis Although diabetes is an established risk factor for myocardial infarction (MI), disease control may vary. HbA(1c) is a reliable index of ambient glucose levels and may provide more information on MI risk than diabetes status.Methods The relationship between HbA(1c) levels in MI patients and controls who participated in the 52 country INTERHEART study was analysed.Results In 15,780 participants with a HbA(1c) value (1,993 of whom had diabetes), the mean (SD) levels for HbA(1c) were 6.15% (1.10) in the 6,761 MI patients and 5.85% (0.80) in the control participants. After adjustment for age, sex and nine major MI risk factors (including diabetes), higher HbA(1c) fifths above the lowest fifth (HbA(1c) <5.4%) were associated with progressively higher OR of MI, with OR for the highest HbA(1c) fifth (>= 6.12%) being 1.55 (95% CI 1.37-1.75). When analysed as a continuous variable after adjustment for the same factors, every 1% higher HbA(1c) value was associated with 19% (95% CI 14-23) higher odds of MI, while every 0.5% higher HbA(1c) was associated with 9% higher odds of MI (95% CI 7-11). Concordant relationships were noted across subgroups, with a higher OR noted in younger people, patients without diabetes or hypertension, and those from some regions and ethnicities.Conclusions/interpretation The HbA(1c) value provides more information on MI odds than self-reported diabetes status or many other established risk factors. Every 1% increment independently predicts a 19% higher odds of MI after accounting for other MI risk factors including diabetes.

    AB - Aims/hypothesis Although diabetes is an established risk factor for myocardial infarction (MI), disease control may vary. HbA(1c) is a reliable index of ambient glucose levels and may provide more information on MI risk than diabetes status.Methods The relationship between HbA(1c) levels in MI patients and controls who participated in the 52 country INTERHEART study was analysed.Results In 15,780 participants with a HbA(1c) value (1,993 of whom had diabetes), the mean (SD) levels for HbA(1c) were 6.15% (1.10) in the 6,761 MI patients and 5.85% (0.80) in the control participants. After adjustment for age, sex and nine major MI risk factors (including diabetes), higher HbA(1c) fifths above the lowest fifth (HbA(1c) <5.4%) were associated with progressively higher OR of MI, with OR for the highest HbA(1c) fifth (>= 6.12%) being 1.55 (95% CI 1.37-1.75). When analysed as a continuous variable after adjustment for the same factors, every 1% higher HbA(1c) value was associated with 19% (95% CI 14-23) higher odds of MI, while every 0.5% higher HbA(1c) was associated with 9% higher odds of MI (95% CI 7-11). Concordant relationships were noted across subgroups, with a higher OR noted in younger people, patients without diabetes or hypertension, and those from some regions and ethnicities.Conclusions/interpretation The HbA(1c) value provides more information on MI odds than self-reported diabetes status or many other established risk factors. Every 1% increment independently predicts a 19% higher odds of MI after accounting for other MI risk factors including diabetes.

    KW - Case-control

    KW - Diabetes

    KW - Dysglycaemia

    KW - Glycated haemoglobin

    KW - Myocardial infarction

    KW - ABNORMAL GLUCOSE REGULATION

    KW - CORONARY-ARTERY-DISEASE

    KW - CARDIOVASCULAR-DISEASE

    KW - 52 COUNTRIES

    KW - DIABETES-MELLITUS

    KW - HEMOGLOBIN A(1C)

    KW - HEART-FAILURE

    KW - BLOOD-GLUCOSE

    KW - MORTALITY

    KW - HOSPITALIZATION

    U2 - 10.1007/s00125-010-1871-0

    DO - 10.1007/s00125-010-1871-0

    M3 - Article

    VL - 53

    SP - 2509

    EP - 2517

    JO - Diabetologia

    JF - Diabetologia

    SN - 0012-186X

    IS - 12

    ER -