Evidence Supports Link Between Blood Glucose and Death Following ACS

An elevated fasting glucose level at hospital admission among patients with acute coronary syndrome (ACS) is associated with increased risk of death and other cardiovascular events up to 6 months later, U.S. researchers report.

The association was particularly strong among patients with ACS who did not have a known history of diabetes.

Dr. Elizabeth A. Jackson of the University of Michigan Health Systems, Ann Arbor, stated that, “This study adds further evidence that suggests clinicians may want to pay attention to fasting glucose levels among ACS patients, including the non-diabetics.”

“Care of ACS patients must include both acute management of the ACS event (and an) understanding of long-term prevention issues.”

The prospective observational study followed all 1,541 patients over 18 admitted to the University of Michigan Health System from 1999 through 2004 who were diagnosed with ACS and for whom the admission fasting glucose level had been recorded. The patients were grouped into three glucose-level categories: 70 mg/dL to less than 100 mg/dL (n = 631), 100 mg/dL to less than 126 mg/dL (n = 499), and 126 mg/dL and over (n = 411).

Twenty-seven patients died during hospitalization. The admission fasting glucose was associated with the risk of death in this period, with death rates of 0.5%, 3.0% and 3.8% for the three categories, respectively. A similar pattern was seen in other major adverse events: stroke, repeat myocardial infarction, ventricular fibrillation and cardiac arrest.

At the highest glucose level, patients with no known history of diabetes showed increased risk for in-hospital death or major adverse events, compared with patients known to have diabetes.

Among the 71 patients who died over a 6-month follow-up period, similar associations were seen. Mortality rates were 3.5% in the lowest group, 6.9% in the middle group and 9.0% in the group with the highest glucose level (p < 0.001). Again, similar associations were seen between elevated fasting glucose and major cardiac adverse events.

The researchers note that the findings regarding patients with no known history of diabetes were consistent with results from numerous previous studies and suggest that this might indicate underdiagnosis of diabetes.