Two-Hour Postload Glucose Test as Predictor of Cardiovascular Events

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Study participants had been hospitalized for a first or recurrent CAD event before the study.
Study participants had been hospitalized for a first or recurrent CAD event before the study.

Two-hour postload glucose (2h-PG) may be a better predictor of cardiovascular events in patients with coronary artery disease (CAD) compared with fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c), according to a report published in Diabetes Care.

Researchers throughout 24 European countries conducted the EUROASPIRE IV (European Action on Secondary and Primary Prevention Through Intervention to Reduce Events) survey from May 2012 to April 2013 to determine the prognostic value of 2h-PG, HbA1c, and FPG with regard to cardiovascular events and incident diabetes.

 

Participants were aged 18 to 80 years without previously known diabetes and had been hospitalized for a first or recurrent CAD event (eg, coronary artery bypass grafting, percutaneous coronary intervention, acute myocardial infarction, or acute myocardial ischemia) 6 to 36 months before the start of the study.

The primary end point was cardiovascular mortality, nonfatal myocardial infarction, stroke, or hospitalization for heart failure, with a secondary end point of incident diabetes.

Of the 3775 participants, 246 experienced the primary end point. FPG and HbA1c did not predict the primary end point, but a 2h-PG (<7.8 vs ≥7.8 mmol/L) was a significant predictor (hazard ratio, 1.38; 95% CI, 1.07-1.78; P =.01). Of the 2609 patients without diabetes at baseline, 78 developed diabetes at 2 years of follow-up. FPG between 6.1 and 6.9 mmol/L did not predict incident diabetes, but HbA1c between 5.7% and 6.5% and 2h-PG between 7.8 and 11.0 mmol/L were independent predictors of disease.

There were 83 deaths recorded during follow-up, with 42 related to cardiovascular causes. The all-cause mortality rate was 10.8 per 1000 person-years, and the cardiovascular mortality rate was 4.6 per 1000 person-years.

"These results confirm guideline recommendations, stressing the importance of the use of [oral glucose tolerance test] as an important tool for the clinical evaluation of patients with CAD," the researchers wrote. "In the era of evidence-based medicine, it seems inappropriate not to perform a simple [oral glucose tolerance test] in patients with CAD."

The researchers noted that a major limitation of their study was that diabetes diagnosis at follow-up was self-reported in 60% of patients because a repeat oral glucose tolerance test could not be conducted. 

Disclosures: Several researchers report financial relationships with Merck Sharp & Dohme Sweden, AstraZeneca Sweden, Sanofi, Novo Nordisk, Bayer Pharma, Boehringer Ingelheim, Merck Serono, Orion Pharma, and Renova. 

Reference

Shahim B, De Bacquer D, De Backer G, et al. The prognostic value of fasting plasma glucose, two-hour postload glucose, and HbA1c in patients with coronary artery disease: a report from EUROASPIRE IV. A survey from the European Society of Cardiology [published online June 21, 2017]. Diabetes Care. doi:10.2337/dc17-0245

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