Deborah Brauser
August 18, 2015
WINSTON-SALEM, NC — The prediabetes marker of impaired fasting glucose (IFG) may also be a predictor of silent MI in adult patients, suggests new research[x].
Additional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) showed that, among nearly 6000 participants, those with IFG were significantly more likely to have an unrecognized MI than those with normal fasting glucose (adjusted odds ratio [OR] 1.60, 95% CI 1.0–2.5).
The association was also significant for the men with IFG vs those without (fully adjusted OR 1.89, P=0.03), but not for the women.
“These people could be at risk and not necessarily know it,” lead author Dr R. Brandon Stacey (Wake Forest University School of Medicine, Winston-Salem, NC) told heartwire from Medscape.
“For clinicians, I’d say the message is simply: once we’ve identified impaired fasting glucose, we’ve identified someone at higher risk for having an MI—whether it’s unrecognized or has a more silent presentation,” said Stacey.
He also suggested that closer screenings should be conducted, “as well as closer scrutiny and investigation if typical or atypical symptoms do develop.”
The findings were published online August 7, 2015 in the American Heart Journal.
Role in the Causal Pathway?
The original MESA study enrolled 6814 adults between the ages of 45 and 84 years at six sites between July 2000 and September 2002. None of the individuals had CV disease or pacemakers.
For this analysis, the investigators evaluated the 5885 participants who also did not have diabetes mellitus at baseline. Of these, 930 had IFG, with the remaining 4955 having normal fasting glucose (control group). IFG was defined as a fasting glucose level between 100 and 125 mg/dL.
If, like diabetes, IFG became an established risk factor for unrecognized MI, “it would represent a significant public-health challenge due to the rapid worldwide increase in IFG prevalence,” write the investigators.
Unrecognized MI was determined in the study by whether a participant had “pathological Q waves or minor Q waves with ST-T abnormalities on initial 12-lead ECG,” they report.
The IFG group had a significantly higher prevalence of unrecognized MI vs the control group (3.5% vs 1.4%, respectively, P<0.001).
In the first model, the adjusted OR (1.78) for unrecognized MI was also significantly higher for those with IFG vs those without IFG (95% CI 1.12–2.77, P=0.02), and this association remained significant even after further adjustments (OR 1.60, P=0.048).
“This observation suggests that the association may be mediated by pathways not shared with other covariates,” including cholesterol, systolic blood pressure, and body-mass index, note the investigators. And the result “further substantiates the central role of IFG and its associated sequelae in the casual pathway for [unrecognized] MI.”
Stacey noted that further research is now needed to determine possible strategies for screening, identifying, and further treating individuals with a silent MI.
MESA was funded by the National Heart, Lung, and Blood Institute. This analysis was funded in part by a grant from the National Institutes of Health. Stacey and the coauthors report no relevant financial relationships.
References
- Stacey RB, Leaverton PE, Schocken DD, et al. Prediabetes and the association with unrecognized myocardial infarction in the Multi-Ethnic Study of Atherosclerosis. Am Heart J 2015; DOI:10.1016/j.ahj.2015.08.003. Abstract