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132 Cardiovascular Risk In Diabetes: Known v/s Unknown

tients with acute coronary syndrome (ACS) could higher CVD morbidity and mortality than the late on-
help in detecting the correct glycemic category than set patients with T2DM . We studied the prevalence
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testing them with FPG alone. We studied clinical util- and pattern of modifiable CVD risk factors including
ity of testing for HBA1c in detecting pre-diabetes and major lipid fractions and systolic and diastolic blood
diabetes among patients without the previous diag- pressure in patients with newly diagnosed T2DM and
nosis of diabetes admitted to hospital with ACS. to detect possible association of these risk factors
with gender, age at onset of diabetes, central obesity
In this cross sectional study conducted in a medical (measured as waist circumference) and global obesi-
ward of a tertiary care hospital in Southern Sri Lan- ty (measured as body mass index). (Table 1)
ka, we included all male and female patients with no
previous history of diabetes admitted over a period From a database which included demographic, clini-
of three months with any of the three types of acute cal and biochemical data of patients who underwent
coronary syndrome; ST elevation myocardial infarc- screening in a diabetes clinic at the time of first di-
tion, non-ST elevation myocardial infarction and un- agnosis of T2DM before commencing any hypogly-
stable angina. cemic, anti -hypertensive or lipid lowering therapy,
we obtained data on their demographic (gender, age)
Of the 125 patients studied, 99 (80%) had normal clinical (height, weight, waist circumference, systolic
fasting plasma glucose (< 125 mg/ dL), 20 (16%) had and diastolic blood pressure) and biochemical (to-
impaired fasting glucose (IFG) (FPG100- 124mg /dL) tal cholesterol, low density lipoproteins (LDL), tri-
and 6 (4%) were newly diagnosed to have diabetes glycerides (TG), high density lipoprotein levels (HDL)
based on FPG. HbA1c levels of all 6 newly diagnosed for analysis. Optimal cutoff levels for blood pressure
patients with diabetes according to FPG ranged from and lipids recommended by the American diabetes
7 – 8.9%. Based on HbA1c, 59 (47%) had diabetes association (ADA) were used to determine the prev-
(HbA1c > 6.5%) and 66 (53%) were in the category of alence of each cardiovascular risk factor needing
pre - diabetes (HbA1c5.5- 6.5%) and none of the study therapeutic intervention. The proportions with systolic
subjects presenting with ACS had HbA1c level below blood pressure ( SBP> 140 mm Hg), diastolic blood
5.5% to be categorized as having normal blood glu- pressure ( DBP>90 mm Hg) , low density lipoprotein
cose (Table 1). Out of the 66 in the pre-diabetes cat- level ( LDL > 100 mg/ dL) , triglycerides( TG> 150 mg/
egory according to HbA1c, only 7 subjects had FPG dL) and high density lipoprotein level ( HDL < 40
in the range of IFG (100-124mg/dL) , leaving 59 (89%) mg/ dL in males and < 50 mg/ dL in females) were
patients with pre-diabetes on HbA1C having normal estimated. Logistic regression analysis was used to
FPG (< 100 mg / dL).
study the association of age, gender, body mass in-
Finding of eight fold (6 vs 50) increase of number dex (BMI) and waist circumference with each of the
of patients with diabetes and two and a half fold in- modifiable cardiovascular risk factor. Age adjusted
crease in the category with pre-diabetes by testing odds ratios were calculated for each parameter risk
for HbA1c compared to FPG among patients in this and level below 0.05 was taken as statistically sig-
study challenges the diagnostic utility of FPG in cor- nificant. Characteristics of the study sample (n=412)
rectly recognizing the glycemic status of individuals and the results from regression analysis are shown
presenting with ACS. It exposes the need for a test in tables 1, 2 and 3.
with better diagnostic yield. Findings of our study
may not be compelling for clinicians to test HbA1c Number of sub- Number of sub-
in each and every patient with ACS with no previous jects according jects according
history of diabetes, but they serve as an eye opener to FPG to HbA1C
of higher prevalence of glucose abnormalities among Normal 99 None
patients with ACS in the Sri Lankan setting.
IFG/pre-diabe- 20 69
tes
Why is young onset T2DM more prone to Diabetes 6 56
CVD than the late onset T2DM?
Pattern of cardiovascular risk factors and their asso- Tables and figures
ciations prevalent among the South Asians may ex- Table1. Number of subjects with acute coronary syn-
plain this higher CVD risk prevalent among patients drome according to fasting plasma glucose (FPG)
with diabetes compared to their Caucasian coun- and glycosylated hemoglobin (HbA1c)
terparts . Furthermore, studies from the west reveal
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that young onset T2DM patients have an early and

GCDC 2017