Hemoglobin A1c Linked to Myocardial Infarction Outcome in Non-Diabetics

Just as the Epic-Norfolk study showed a 28% increase in cardiovascular death from those that had an A1c of 5% compared to those with a 6%, in this study they found that higher levels of glycated hemoglobin (HbA1c) is associated with poor outcomes after myocardial infarction (MI) in patients without diabetes.

Just as the Epic-Norfolk study showed a 28% increase in cardiovascular death from those that had an A1c of 6% compared to those with a 5%, in this study they found that higher levels of glycated hemoglobin (HbA1c) is associated with poor outcomes after myocardial infarction (MI) in patients without diabetes.

Dr. Ida Gustafsson from Roskilde University Hospital, Denmark, stated that, “Patients not previously diagnosed with diabetes, who have dysglycemia revealed in the setting of an acute coronary event, are at particular high risk, warranting an aggressive intervention with preventive strategies according to current guidelines.”

Dr. Gustafsson and associates in the OPTIMAAL Study Group examined the prognostic effect of HbA1c level on long-term mortality and morbidity in patients after MI. In the OPTIMAAL trial (which compared losartan to captopril), 2841 participants had HbA1c measured at baseline.

Crude mortality following MI in nondiabetic patients was 13% with HbA1c below 4.9%, 17% in patients with HbA1c between 4.9% and 5.1%, and 22% in those with HbA1c above 5.1%, the authors report. That compares to 18% mortality in patients with a history of diabetes.

HbA1c did not influence the mortality risk among patients with a history of diabetes, the report indicates, but each 1% absolute increase in HbA1c was associated with a 24% increase in mortality among patients without a history of diabetes.

“All patients hospitalized for acute coronary syndromes should be screened for glucometabolic disturbances,” Dr. Gustafsson recommended. “An elevated HbA1c should provoke diagnostic testing with fasting plasma glucose.”

Am Heart J : Sept, 2007;154:470-476.

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