A glycemic variability cutoff value of >2.7 mmol/L is the strongest independent predictive factor for midterm major adverse cardiac events in patients with diabetes and acute coronary syndrome, according to study results published in Diabetes Care.
To investigate the relationship between glycemic variability and the occurrence of midterm major cardiovascular events, researchers assessed glycemic variability in 327 consecutive patients (average age, 69 years) hospitalized with diabetes and acute coronary syndrome. Each patient was evaluated for glycemic variability at enrollment and was monitored during follow-up for such major cardiovascular events as new-onset myocardial infarction, acute heart failure, and cardiac death.
Of the total population, 89 (27.2%) people experienced a major cardiovascular event during a mean follow-up of 16.9 months; 24 patients died of cardiac causes, 35 had new-onset myocardial infarction, and 30 were hospitalized because of acute heart failure.
Using multivariable logistic regression analysis, the researchers found multiple independent predictive factors of midterm major cardiovascular events, including a glycemic variability value >2.7 mmol/L (odds ratio [OR], 2.21; 95% CI, 1.64-2.98; P <.001), a Synergy between PCI with Taxus and Cardiac Surgery score >34 (OR, 1.88; 95% CI, 1.26-2.82; P =.002), and reduced ventricular ejection fraction <40% (OR, 1.71; 95% CI, 1.14-2.54; P =.009). However, a Global Registry of Acute Coronary Events risk score >140 was determined not be an independent predictor (OR, 1.07; 95% CI, 0.77-1.49; P =.69).
There were several limitations to this study, including lack of a universally accepted score for general risk for cardiovascular events.
Based on their findings that glycemic variability is a strong predictor, the researchers said that high glycemic variability “must at least alert physicians in charge of patients to their potential cardiovascular risk. Other prospective trials are needed to consider short-term [glycemic variability] as an independent risk factor for diabetic complications.”
Gerbaud E, Darier R, Montaudon M, et al. Glycemic variability is a powerful independent predictive factor of midterm major adverse cardiac events in patients with diabetes with acute coronary syndrome [published online February 6, 2019]. Diabetes Care. doi:10.2337/dc18-2047