Study On The Correlation Between Abnormal Glucose Metabolism And Short-term And Long-term Prognosis Of Patients With Cardiovascular Diseas

Background:Sufficient research evidence shows that acute hyperglycemia at admission is independently associated with short-term and long-term adverse events in patients with acute coronary syndrome(ACS).However,the admission blood glucose(ABG)can not truly and effectively reflect the acute hyperglycemia state,because it is also affected by the chronic blood glucose control level.In recent years,some studies have indicated that a novel marker described as the stress hyperglycemia ratio(SHR)could reflect true acute hyperglycemic status and was associated with the short-term poor prognosis in patients with acute myocardial infarction.However,it is not clear whether SHR is independently related to the long-term prognosis of ACS patients.Objective:The current study aimed to evaluate the association of SHR with adverse cardiovascular events among patients with ACS.Methods:This study consecutively enrolled 5,562 ACS patients who underwent drugeluting stent(DES)implantation at Fuwai Hospital.All subjects were divided into five groups according to SHR,which was determined by the following formula:ABG(mmol/L)/[(1.59 × HbAlc%)-2.59],where ABG is admission blood glucose level.The primary endpoint was major adverse cardiovascular and cerebrovascular events(MACCE)at the 2-year follow-up,and the secondary endpoint included major adverse cardiovascular events(MACCE)at 2-year follow-up,cardiac death,and nonfatal myocardial infarction(MI)at 2-year follow-up and in-hospital cardiac death and nonfatal MI.Results:A total of 643 MACCE were recorded during a median follow-up of 28.3 months,including 72 all-cause deaths,37 cardiac deaths,259 nonfatal myocardial infarction,97 nonfatal stroke,and 264 target vessel revascularization.Kaplan-Meier survival analysis showed the lowest MACCE incidence in quintile 3(P<0.001).In addition,the results of restricted cubic spline(RCS)analysis showed that there were Ushaped associations of the SHR with the MACCE rate and MACE rate at 2-year followups even after adjustment for other confounding factors(all P values for nonlinearity<0.05),while there were J-shaped associations of SHR with in-hospital cardiac death and MI and that at 2-year follow-up(all P values for nonlinearity<0.05).The value of the SHR corresponding to the lowest risk of every endpoint on multivariate-adjusted RCS analyses was 0.78 for the overall population.Conclusions:There were U-shaped associations of SHR with MACCE rate and MACE rate at 2-year follow-ups and J-shaped associations of SHR with in-hospital cardiac death and MI and that at 2-year follow-up in ACS patients who underwent DES implantation,and the inflection point of SHR for poor prognosis was 0.78.The cardiovascular risk increases in all situations that depart from the linear correlation between ABG and HbAlc in both directions.In clinical practice,attention should be paid to the management of acute blood glucose fluctuations in patients with ACS.Background:Various acute and critical diseases often accompany the occurrence of stress induced hyperglycemia,and can worsen the outcome of the disease.Previous studies have mostly used the absolute value of admission blood glucose to determine whether a patient undergo stress induced hyperglycemia.However,the absolute value of admission blood glucose(ABG)is difficult to truly and effectively reflect the acute hyperglycemia state,as it is also affected by the patient’s chronic blood glucose background.In recent years,some research results have shown that stress hyperglycemia ratio(SHR)can reflect the true state of acute hyperglycemia,eliminate the impact of chronic blood glucose background,and it is closely related to the short-term prognosis of patients with acute myocardial infarction(AMI).However,it is unclear whether SHR is independently associated with poor prognosis in patients with acute myocarditis.Objective:This study aimed to further assess the correlation between SHR and shortterm and long-term adverse outcomes in patients with acute myocarditis.Methods:We retrospectively screened 269 patients with acute myocarditis hospitalized in Fuwai Hospital from 2006 to 2020.According to the inclusion and exclusion criteria,185 patients were ultimately enrolled.The calculation formula for SHR is:SHR=admission blood glucose(mmol/L)÷[(1.59 × HbA1c%)-2.59].The primary endpoint was defined as in-hospital major adverse cardiovascular events,including all-cause death,heart transplantation,the need for mechanical circulatory support(MCS),and transfer to the intensive care unit(ICU).The secondary endpoint was defined as long-term MACE,a composite endpoint of all-cause death,heart transplantation,recorded sustained ventricular arrhythmia(>30s),heart failure requiring hospitalization,and myocarditis relapse.Results:Subjects in the higher SHR group had more serious conditions,including lower systolic blood pressure,higher heart rate,higher white blood cell count,higher levels of alanine transaminase,troponin I,and C-reactive protein,and worse cardiac function.Multivariate logistic analysis showed that an SHR>1.12(HR:3.95,95%CI:1.10-14.18,P=0.035)was independently associated with in-hospital MACE in patients with acute myocarditis.The outcomes of Kaplan-Meier survival analysis and multivariate Cox analysis suggested that an SHR>1.39(HR:1.93,95%CI:0.32-2.68,P=0.895)was not significantly associated with long-term prognosis.Conclusions:The SHR was independently associated with in-hospital adverse outcomes in patients with acute myocarditis but not with long-term prognosis.In the future,doctors should pay attention to the management of acute blood glucose fluctuations in patients with acute myocarditis.Background:In recent years,with the improvement of living standards,the incidence of metabolic disorders such as diabetes,prediabetes,insulin resistance and metabolic related fatty liver disease is increasing.Metabolic disorders centered around insulin resistance are important risk factors for cardiovascular diseases,especially coronary heart disease(CHD).The triglyceride-glucose index(TyG index)is a valuable marker for predicting adverse cardiovascular events in diabetic patients.However,for nondiabetic patients,whether the TyG index is independently related to poor prognosis remains unclear.Objective:This cohort study aimed to assess the association of the TyG index with future cardiovascular risk in nondiabetic subjects who received percutaneous coronary intervention(PCI).Methods:We consecutively enrolled 5,489 nondiabetic patients who underwent PCI at Fuwai Hospital.All experimental subjects were divided into three groups based on their TyG index,which was determined by the equation ln(fasting triglyceride(mg/dl)×fasting blood glucose(mg/dl)/2).The primary endpoint was major adverse cardiovascular and cerebrovascular events(MACCE),including all-cause death,nonfatal myocardial infarction(MI,.nonfatal stroke,and target vessel revascularization(TVR).The secondary endpoints included major adverse cardiovascular events,all-cause death.cardiac death,nonfatal stroke,non-fatal MI.and TVR.Results:A total of 386 MACCE were documented during a median 29-month follow-up.The Kaplan-Meier survival results indicated that among the three groups,there was no obvious difference in any endpoints.Further Cox regression analyses suggested that the TyG index was not independently related to adverse cardiovascular outcomes for nondiabetic patients who underwent PCI(HR:0.77.95%CI:0.56-1.16,P=0.210 for MACCE).Subgroup analysis suggested that the TyG index was independently relevant to MACCE for patients with low-density lipoprotein cholesterol(LDL-C)lower than 1.8 mmol/L.Conclusion:The TyG index is not an effective predictive factor for adverse cardiovascular prognosis in nondiabetic patients who underwent PCI.However,in subjects with LDL-C lower than 1.8mmol/L,it may predict future cardiovascular risk.TyG index is one of the sources of residual cardiovascular risk in nondiabetic patients with coronary heart disease whose LDL-C is well controlled.