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Hyperglycemia and Incidence of Subclinical Myocardial Damage

Hyperglycemia associated with myocardial damage appears to begin before the diagnosis of diabetes and requires a highly sensitive assay to detect it…

Cardiovascular disease is the leading cause of death among individuals with diabetes. Hyperglycemia is believed to induce coronary microvascular dysfunction and result in myocardial injury. Previous studies have shown elevated blood glucose levels have an increased prevalence of atherosclerosis but the relationships between diabetes and subclinical myocardial damage are still unknown.

The study objective was to distinguish the associations of diabetes and pre-diabetes with 6-year incidence of subclinical myocardial injury measured by hs-cTnT in population without cardiovascular disease. The secondary outcome was to evaluate the associations of elevated hs-cTnT with coronary heart disease, heart failure, and mortality in individuals with and without diabetes. Cardiac troponins with highly sensitive (hs-cTnT) are the standard measure used for the diagnosis of myocardial infarction; it is elevated in individuals with myocardial damage.

In the results, 3.7% of individuals had elevated troponin levels with normal baseline compared to 6.4% of those with pre-diabetes and 10.8% with diabetes. Incidence of elevated troponin levels were associated with coronary heart disease (3.84; 95% CI 2.52-5.84), heart failure (6.37; 95% CI, 4.27-9.51), and mortality (4.36; 95% CI, 3.14-6.07) versus those troponin levels remained normal and who did not have diabetes.

In conclusion, the study provides evidence of the harmful effect of hyperglycemia on the myocardium even in individuals under the threshold for the diagnosis of diabetes mellitus. Individuals with subclinical myocardial damage were at a higher risk for cardiovascular events and mortality.

Practice Pearls:

  • Hyperglycemia associated with myocardial damage appears to begin before the diagnosis of diabetes and requires a highly sensitive assay to detect it.
  • The risk of cardiovascular events especially heart failure is high among individuals who will subsequently develop diabetes.
  • Treating patients with these conditions requires a multidimensional approach that controls risk factors.

Selvin E, Lazo M, Chen Y, et al. “Diabetes Mellitus, Prediabetes, and incidence of subclinical myocardial damage”. American Heart Association. August 22, 2014.http://circ.ahajournals.org/content/130/16/1374.long#sec-16