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September 11, 2019Journal of Thrombosis and ThrombolysisOpen Access

Prevalence and relevance of abnormal glucose metabolism in acute coronary syndromes: insights from the PLATelet inhibition and patient Outcomes (PLATO) trial

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Why the study?

Diabetes mellitus and abnormal glucose metabolism are associated with cardiovascular disease, motivating investigation into the prevalence and prognostic importance of dysglycaemia in patients with acute coronary syndromes.

Does abnormal glucose metabolism (diabetes or prediabetes) increase the risk of cardiovascular events in patients with acute coronary syndromes?

Population

16,007 ACS patients in the PLATO trial with HbA1c and/or glucose levels available

Comparison

Diabetes mellitus vs prediabetes vs no diabetes

Design

Post-hoc analysis of a randomized clinical trial cohort

Follow-up

12 months

Key result

In patients with acute coronary syndromes, definite diabetes mellitus was associated with an increased risk of cardiovascular death, spontaneous myocardial infarction, or stroke at 12 months (adjusted HR 1.39) compared to normoglycemia, whereas prediabetes was not.

Authors

AÅAxel ÅkerblomDWDaniel WojdylaPSPhilippe Gabríel Steg

Discussion

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Member takes

Overview

Supports diabetes-specific risk stratification in ACS; leaves open prediabetes prognostic value and need for intervention trials.

Study Design

Type

Cohort (n=16,007)

Multicenter

Yes

Structured PICO

Does abnormal glucose metabolism (diabetes or prediabetes) increase the risk of cardiovascular events in patients with acute coronary syndromes?

P
Population
16,007 patients with acute coronary syndromes from the PLATO trial, stratified by baseline glycaemic status, followed for 12 months.
E
Exposure
Abnormal glucose metabolism (diabetes mellitus defined as known diabetes, HbA1c ≥ 6.5%, or non-fasting glucose ≥ 11.1 mmol/L; prediabetes defined as HbA1c ≥ 5.7% but < 6.5%).
C
Comparator
No diabetes (HbA1c < 5.7%).
O
Outcome
Composite of cardiovascular death, spontaneous myocardial infarction type 1 (sMI), or stroke at 12 months.composite

Main Result

Hazard Ratio: 1.39 (95% CI 1.11–1.74)

Absolute Event Rate: 12.2% vs 6.3%

In patients with acute coronary syndromes, manifest diabetes is associated with an increased risk of cardiovascular events at 1 year, whereas prediabetes is not immediately associated with worse outcomes compared to normoglycemia.

Limitations

  • Manifest DM was an enrichment criterion for entering the PLATO trial with non-STEACS, likely leading to a larger proportion of diagnosed DM patients than typical ACS populations.
  • Follow-up was limited to one year, which may not be long enough to observe the detrimental effects of newly diagnosed DM or pre-DM.
  • The study was an observational substudy not specifically designed to answer questions about the long-term pathogenic threshold of dysglycemia.
  • Short follow-up duration of up to one year
  • Study was not specifically designed to answer these questions (post-hoc/substudy analysis)

Cite This Study

Åkerblom et al. (2019) conducted a cohort in Acute coronary syndromes (n=16,007). Diabetes mellitus vs. No diabetes (normoglycemia) was evaluated on Composite of cardiovascular death, spontaneous myocardial infarction type 1, or stroke at 12 months (HR 1.39, 95% CI 1.11-1.74). In patients with acute coronary syndromes, definite diabetes mellitus was associated with an increased risk of cardiovascular death, spontaneous myocardial infarction, or stroke at 12 months (adjusted HR 1.39) compared to normoglycemia, whereas prediabetes was not.

synapsesocial.com/papers/6a959be53d7e4fca39b2ef0bhttps://doi.org/10.1007/s11239-019-01938-2
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