Section on Cardiology, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Department of Epidemiology and Biostatistics, College of Public Health University of South Florida, Tampa, Florida.
J Am Geriatr Soc. 2019 Jan;67(1):43-49. doi: 10.1111/jgs.15604. Epub 2018 Oct 9.
To investigate glucose levels as a risk factor for unrecognized myocardial infarctions (UMIs).
Cohort SETTING: Cardiovascular Health Study.
Individuals aged 65 and older with fasting glucose measurements (N=4,355; normal fasting glucose (NFG), n = 2,041; impaired fasting glucose (IFG), n = 1,706; DM: n = 608; 40% male, 84% white, mean age 72.4 ± 5.6).
The relationship between glucose levels and UMI was examined. Participants with prior coronary heart disease (CHD) or UMI on initial electrocardiography were excluded. Using Minnesota codes, UMI was identified according to the presence of pathological Q-waves or minor Q-waves with ST-T abnormalities. Crude and adjusted hazard ratios (HRs) were calculated. Analyses were adjusted for age, sex, body mass index (BMI), hypertension, antihypertensive and lipid-lowering medication use, total cholesterol, high-density lipoprotein cholesterol, and smoking status.
Over a mean follow-up of 6 years, there were 459 incident UMIs (NFG, n=202; IFG, n=183; DM, n=74). Participants with IFG were slightly more likely than those with NFG to experience a UMI (hazard ratio (HR)=1.11, 95% confidence interval (CI)=0.91-1.36, p = .30), and those with DM were more likely than those with NFG to experience a UMI (HR=1.65, 95% CI=1.25-2.13, p < .001). After adjustment HR for UMI in IFG those with IFG were no more likely than those with NFG to experience a UMI (HR=1.01, 95% CI=0.82-1.24, p = .93), whereas those with DM were more likely than those with NFG to experience a UMI (HR=1.37, 95% CI=1.02-1.81, p = .03). The 2-hour oral glucose tolerance test was not statistically significantly associated with UMI.
Fasting glucose status, particularly in the diabetic range, forecasted UMI during 6 years of follow-up in elderly adults. Further studies are needed to clarify the level of glucose at which risk is greater. J Am Geriatr Soc 67:43-49, 2019.
探讨血糖水平是否为未识别心肌梗死（UMI）的危险因素。
队列研究
心血管健康研究。
年龄在 65 岁及以上，空腹血糖测量值（N=4355；正常空腹血糖（NFG），n=2041；空腹血糖受损（IFG），n=1706；DM：n=608；40%为男性，84%为白人，平均年龄 72.4±5.6）。
研究人员检查了血糖水平与 UMI 之间的关系。将初始心电图有冠心病（CHD）或 UMI 的参与者排除在外。根据病理性 Q 波或伴 ST-T 异常的小 Q 波，使用明尼苏达州编码法确定 UMI。计算了未调整和调整后的危险比（HR）。分析调整了年龄、性别、体重指数（BMI）、高血压、降压和降脂药物的使用、总胆固醇、高密度脂蛋白胆固醇和吸烟状况。
在平均 6 年的随访期间，发生了 459 例新发 UMI（NFG，n=202；IFG，n=183；DM，n=74）。IFG 组发生 UMI 的可能性略高于 NFG 组（HR=1.11，95%置信区间（CI）=0.91-1.36，p=0.30），DM 组发生 UMI 的可能性高于 NFG 组（HR=1.65，95% CI=1.25-2.13，p<0.001）。IFG 患者 UMI 的调整后 HR 表明，与 NFG 患者相比，IFG 患者发生 UMI 的可能性没有更高（HR=1.01，95% CI=0.82-1.24，p=0.93），而 DM 患者发生 UMI 的可能性高于 NFG 患者（HR=1.37，95% CI=1.02-1.81，p=0.03）。2 小时口服葡萄糖耐量试验与 UMI 无统计学显著相关性。
在老年人 6 年的随访中，空腹血糖状况，尤其是糖尿病范围的血糖状况，预测了 UMI。需要进一步的研究来阐明风险更大的血糖水平。美国老年医学会 67:43-49,2019。
