Get started
Work

La variabilite glycemique : un facteur de risque cardiovasculaire?

Year: 2017
Type: dissertation
Study design: Observational Study
Abstract: . Objective Glycemic variability (GV) seems to be related to the occurrence of complications in patients with diabetes. However, the relationship between GV level and the occurrence of mid-term major cardiovascular event in patients with diabetes remains unclear. We evaluated the association between GV and the mid-term occurrence of major adverse cardiac event (MACE) in diabetic patients presenting with acute coronary syndrome (ACS). Research design and Methods. This retrospective analysis included a cohort of 339 consecutive diabetic patients presenting with ACS between January 2015 and November 2016. A discontinuous glucose monitoring was performed during the hospital stay. GV was assessed by using standard deviation (SD). Two analysis were carried out, one using a cut-off of 50mg/dl (SD) to determine two groups: high GV [>50mg/dl(SD)] and low GV [<50mg/dl(SD)], and the other one using three groups per tertile of GV. Results. Type 2 diabetes was largely predominant (93.5%). There was 8 (2.7%) newly diagnosed diabetes. Mean HbA1C measured during hospitalization was 7.55%. With a mean follow-up of 16.1 months, 87 patients (29.6%) presented at least one MACE. Female gender, age, known cardiovascular risk factors (smoking status, LDL-C value), previous coronary artery disease (CAD), a three-vessel disease, Killip class ≥ 2, left ventricular ejection fraction (LVEF), BNP value, the occurrence of acute kidney failure, vasopressor/inotropic agents use, insulin therapy at hospital discharge, high level of hyperglycemia during hospitalization and elevation of GV [>50mg/dl(SD) and 3rd tertile] were associated with the occurrence of MACE (p < 0.05) in the univariate analysis. Multivariate analysis, including variables with a significance level of p < 0.2 in univariate analysis, showed that Killip class ≥ 2, high GV by using the cut-off of 50 mg/dl(SD) and the 3rd GV tertile were strongly associated with the occurrence of MACE (p = 0,006, p = 0.014 and p = 0.04 respectively). Conclusions. GV in diabetic patients presenting with ACS is a powerful independent predictive factor of midterm MACE.
Source: HAL
Language: French
Field: Medicine
Open Access status: green
OpenAlex ID: W2792691138
Cites:
Cited by:
Related to: 10