Incidence, coronary risk profile and angiographic characteristics of prediabetic and diabetic patients in a population with ischemic heart disease.

BACKGROUND

Recently, the threshold of fasting blood glucose indicating diabetes mellitus was lowered to 7.00 mmol/L (126 mg/dL) and the term 'impaired fasting glucose' (IFG; fasting blood glucose ranging from 6.11 mmol/L to 6.99 mmol/L or from 110 mg/dL to 126 mg/dL) was introduced to define a prediabetic state.

OBJECTIVE

To evaluate the incidence of the above states in a Canadian population with suspected coronary artery disease and to compare their risk profiles and angiographic status to normoglycemic subjects.

PATIENTS AND METHODS

Revision of the database of 1108 consecutive patients (793 males and 315 females; mean age 58.1+/-9.8 years) undergoing clinical, biochemical and elective angiographic studies because of suspected coronary artery disease.

RESULTS

One third of the patients had either IFG (8.5%), or were diabetics (24.2%). Unlike the 747 normoglycemic patients, both IFG (n=94) and diabetic (n=267) subjects showed an insulin resistance profile, with abdominal obesity, and dislipidemia characterized by high triglycerides in the presence of low high density lipoprotein-cholesterol and high normal or elevated blood pressure. Both prediabetics and diabetics had a significantly higher homeostatic model assessment insulin resistance index than normoglycemics (P<0.0001), the index also being higher for diabetics than for prediabetics (P<0.0001). Coronary atherosclerosis was documented in most patients of the three groups and was significantly more severe in diabetics than in IFG patients (P=0.0359) or normoglycemics (P=0.0069), with no differences between the former two groups.

CONCLUSIONS

As expected, the new definitions identify more patients with impaired homeostasis than earlier criteria. IFG patients have similar coronary risk profile as diabetics, suggesting the need for similar coronary precautions.