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Title: Detection of glucose metabolism disturbances in patients with coronary heart disease – single measurements of fasting glucose or oral glucose tolerance test

Jolanta Bożena Prokop, Włodzimierz J. Musiał, Hanna Bachórzewska-Gajewska, Irina Kowalska, Beata Telejko, Ida Kinalska, Wacław Kochman
Original articles
Polish Journal of Cardiology
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Final page:
disturbances of glucose metabolism, coronary heart disease, oral glucose tolerance test

Introduction: Disturbances of glucose metabolism are strong and independent risk factors of coronary heart disease (CHD). The incidence of CHD is 2-4 times higher in patients with diabetes mellitus. However, in the published data the incidence of diabetes varies in patients with CHD. Aim: The aim of this study was to estimate the prevalence of the disturbances of carbohydrates metabolism in patients with known CHD without history of diabetes. Material and methods: The study group consisted of 266 men with CHD, without a history of diabetes referred for coronary angiography. The patients were divided into four groups according to the coronarography results. Group 0 consisted of the individuals without changes in coronary arteries. Group I, II and III included the patients with one, two and three vessel disease, respectively. The standard oral glucose tolerance test (OGTT) was performed in all cases. We estimated also the hemoglobin A1c level (HbA1c), total cholesterol, LDL and HDL cholesterol as well as concentration of triglicerides. Results: Glucose metabolism disturbances were present in 144 patients (54%) with known CHD; 36% showed impaired glucose tolerance (IGT), 18% diabetes mellitus type 2. In all groups the average fasting glucose levels were within the range of normal. In the majority of cases glucose disturbances were revealed due to abnormal OGTT. The prevalence of abnormal glucose metabolism was significantly higher in group II and III in comparison to group 0 and I. The mean value of HbA1c increased markedly with the degree of coronary artery pathologic changes. The significant correlation between HbA1c and fasting glucose was observed similarly to correlation between HbA1c and number of involved vessels. The lipid profile was particularly abnormal in groups II and III. Conclusions: The obtained results suggest that disturbances of glucose metabolism are frequently present in patients with CHD without history of diabetes. However, single measurements of fasting glucose level were not sufficient to show these abnormalities. Oral glucose tolerance test had to be performed in patients with CHD on regular bases. Hiperglycemia was an important risk factor in the development of coronary artery stenosis. The close correlation between the level of glicemia in the 120th minute of OGTT and the number of involved coronary arteries was stated.