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Item
#6
Hyperglycemia
in Absence of Diabetes Diagnosis Predicts Poor Outcome After AMI
Outcomes
are worse for those patients with hyperglycemia at the time of an
acute myocardial infarction, more so then those already diagnosed with
diabetes.
Hyperglycemia
at the time of acute myocardial infarction (AMI) remains an
independent predictor of mortality in the thrombolytic era. According
to a team of Canadian researchers, the outcome is even worse for
patients not previously diagnosed with diabetes.
These
findings, say Dr. Jafna L. Cox and associates of Dalhousie University
in Halifax, Nova Scotia, "lend support for aggressive screening
strategies aimed at the early recognition of diabetes."
As
part of the prospective-cohort project, Improving Cardiovascular
Outcomes in Nova Scotia (ICONS), Dr. Cox's group conducted an
extensive chart review of all 1,644 Nova Scotia residents hospitalized
for AMI during the interval between October 1997 and October 1998.
Hyperglycemia was defined as random blood glucose > 198 mg/dL. They
describe their research in the Journal of the American College of
Cardiology for November 20.
Diabetics
with normal blood glucose comprised 10.2% of the cohort, and
hyperglycemic diabetics, 16.9%. Patients who were not previously known
to have diabetes but who presented with hyperglycemia made up 8.1%,
while the remainder of individuals had no history of diabetes and
normal blood sugar measurements.
Multivariate
analysis revealed that in-hospital mortality was 2.44-fold higher
among patients with hyperglycemia without a previous diagnosis of
diabetes compared with their normoglycemic counterparts. The odds
ratio for diagnosed diabetes without hyperglycemia was 1.87, and for
those with hyperglycemia it was 1.91.
"Patients
known to have diabetes and those with hyperglycemia without a history
of diabetes continued to suffer a relatively worse outcome even up to
one year," the Canadian physicians found.
Neither
body mass index nor lipid levels were independently correlated with
outcome, they note. Thus, it appears that blood glucose alone, rather
than hyperglycemia as part of a metabolic syndrome, was associated
with adverse prognosis. J
Am Coll Cardiol 2002;40:1748-1754.
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DID
YOU KNOW:
On
average, persons with diabetes ages 18 to 64 lost 8.3 days per year
from work (American Diabetes Association, 1998).
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