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Title: Diabetes and impaired fasting glucose as predictors of morbidity and mortality in male coronary artery disease patients with reduced left ventricular function
Author(s): VAN DE VEIRE, Nico R. , DE WINTER, Olivier , GILLEBERT, Thierry C. , DE SUTTER, Johan
Journal: Acta Cardiologica
Volume: 61    Issue: 2   Date: April 2006   
Pages: 137-143
DOI: 10.2143/AC.61.2.2014326

Abstract :
Objectives — To evaluate the prognostic value of impaired fasting glucose and diabetes mellitus in male patients with coronary artery disease and poor left ventricular function.

Methods and results — From a prospective database on patients referred for gated myocardial perfusion imaging between 1998 and 2002 all male patients with a history of coronary artery disease and poor left ventricular function were selected.Poor function was defined as left ventricular ejection fraction ≤ 40%. Subjects were classified as non-diabetics with fasting blood glucose levels < 110 mg/dL, non-diabetics with impaired fasting glucose (fasting blood glucose between 110 and 125 mg/dL) and diabetics. Median follow-up was 2.7 years. End points were all-cause mortality, cardiac death and hospitalization for heart failure.One hundred and sixty patients were selected (age 65 ± 9 years and left ventricular ejection fraction 29 ± 8%).In univariate analysis atrial fibrillation, NYHA class, glycaemia and diabetes mellitus discriminated between survivors and non-survivors.In Cox multivariate regression analysis for all-cause mortality only NYHA class and diabetes mellitus remained significant. Kaplan Meier analysis showed that diabetics had the worst survival and non-diabetics with glucose ± 110 mg/dL had the best survival. Non-diabetics with impaired fasting glucose had intermediate survival.Analysis for cardiac death/hospitalization for heart failure showed similar results.

Conclusion — In male patients with coronary artery disease and impaired left ventricular function diabetes mellitus and fasting glucose are strongly predictive of poor outcome. Diabetics have the worst prognosis but non-diabetics with impaired fasting glucose also are at higher risk compared to non-diabetics with low fasting blood glucose.