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Endocrinology - Hellerman |
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DM News Update |
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Hyperglycemia Starts at 90 mg/dL Mitchel L. Zoler ATLANTA — The standard threshold for hyperglycemia may be too high. People with a fasting serum glucose level of 100-125 mg/dL had an adjusted, 2.8-fold higher risk of having had a coronary heart disease event than people with a fasting glucose level of less than 79 mg/dL, in a cross-sectional study of 2,440 people, Dr. Dennis L. Sprecher said at the annual meeting of the American College of Cardiology. A fasting serum glucose level of more than 125 mg/dL is the current threshold for identifying patients with diabetes. But the new finding suggests that patients with high levels of serum glucose in the nondiabetic range also face a substantial risk of having coronary heart disease. At the Cleveland Clinic Foundation “we now use a fasting serum glucose of 90 mg/dL or higher as a biomarker of coronary heart disease risk,” said Dr. Sprecher, head of the foundation's section of preventive cardiology. “The cutoff of 125 mg/dL was based on the incidence of diabetic retinopathy,” but physicians now increasingly focus on the diabetes-related risk of coronary heart disease, he said. As evidence accumulates, the definition of diabetes may change. The study participants were seen at the preventive cardiology clinic from January 1996 through February 2001. All had fasting serum glucose levels in the nondiabetic range. They had been referred to the clinic for treatment of lipid or blood pressure abnormalities, or for the prevention of coronary heart disease. The patients were judged to have existing coronary heart disease if they had a documented myocardial infarction; coronary catheterization showing more than 50% stenosis of a major coronary artery; a history of coronary bypass surgery or a percutaneous coronary procedure; or a functional cardiac study that showed coronary artery disease (such as a stress echocardiogram or a stress thallium examination). A total of 1,274 (52%) of these people had known coronary heart disease. Fasting serum glucose levels in these people ranged from 37 to 125 mg/dL, with a mean of 89 mg/dL, Dr. Sprecher said. For this analysis, the study participants were divided into quintiles based on their fasting serum glucose level. The lowest quintile had levels of 79 mg/dL or less; the highest quintile had levels of 100-125 mg/dL. The multivariate analysis that examined the relationship between fasting serum glucose and coronary heart disease controlled for body mass index, the Framingham risk score, and nontraditional risk factors such as fibrinogen, homocysteine, and lipoprotein (a). The absolute prevalence of coronary heart disease was 65% in the highest quintile and 43% in the lowest quintile. When the analysis controlled for all other risk factors, the men in the highest serum glucose quintile had a 2-fold higher risk of coronary heart disease, compared with the men in the lowest quintile. The women in the highest quintile had a 3.5-fold higher risk, compared with the women in the lowest quintile. “We try to intervene with exercise, diet, and weight control.” These people may also be candidates for treatment with a drug such as metformin, he said.
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Last Modified: Tuesday January 27 2004
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