The Effect Of Stress Hyperglycemia On Plasma Adiponectin In Patients With Acute Coronary Syndrome

Objective: In patients with Acute Coronary Syndrome(ACS), hyperglycemia on admission is associated with an increased risk of mortality and congestive heart failure, and it even has advanced effect on left ventricular remodeling and prognosis as well. The association is observed irrespective of diabetic status but is stronger in nondiabetic patients. However, the mechanisms underlying this association are still unknown. Studies have shown that stress hyperglycemia may be associated with abolishing ischemic preconditioning and promoting apoptosis; endothelial dysfunction; coronary collateral expansion of non-performing; increased platelet aggregation and higher thromboxane A2 and von Willebrand factor activity; increased markers of vascular inflammation; oxidative stress; and increased myocardial consumption of oxygen. Given the multiple detrimental effects of stress hyperglycemia on the cardiovascular system, it is possible that during hospitalization hyperglycemia may have a direct effect on outcomes in patients with ACS. Adiponectin has many biological effects including increasing insulin sensitivity, anti-diabetic,anti-atherosclerosis, anti-inflammatory, inhibiting proliferation of cardiac hypertrophy and so on. Studies have found that in patients with acute coronary syndrome (acute myocardial infarction AMI and unstable angina pectoris UAP) plasma adiponectin level is significantly lower than the stable angina group and the healthy control group. Multiple regression analysis show that plasma concentration of adiponectin is independently associated with occurrence of acute coronary syndromes. In this study we investigated the difference between stress hyperglycemia and non-stress hyperglycemia patients in plasma adiponectin levels, left ventricular remodeling and prognosis .and further explored the effect of stress hyperglycemia on plasma concentration of adiponectin and left ventricular remodeling in patients with Acute Coronary Syndrome.Methods: 80 non-diabetic patients with ACS were enrolled in this study (62 male, 18 female, aged 39-82). The fasting glucose and 2 hours postprandial glucose were detected on the second day after admission. According to the fasting glucose levels, patients were divided into stress hyperglycemia (SH) group (FG≥7.0 mmol/L) and non-stress hyperglycemia (non-SH) group (FG <7.0 mmol/L). There were 38 cases in the stress hyperglycemia group, and 42 cases in the non-stress hyperglycemia group. The plasma concentration of adiponectin was detected 72 hours after heart attack; left ventricular end-diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI) and left ventricular ejection fraction(LVEF) were respectively measured by echocardiography on two weeks and three months. All cases were followed up for 3 months, recorded the major adverse cardiovascular events (MACE), including non-fatal myocardial infarction, heart failure and cardiac sudden death. Telephone interview would be carried out, if patients failed to out-patient follow-up.Results: Compared with the non-stress hyperglycemia group, the plasma concentration of adiponectin in stress hyperglycemia group was significantly lower(3.70±1.59 vs 5.56±1.85μg/ml, P<0.01) ; The changes in LVEDVI and LVESVI from baseline to 3 months were 4.39±2.59 and 1.93±1.08 ml/m2, respectively, in patients with stress hyperglycemia vs 2.74±2.20 and 0.91±0.79 ml/m2, respectively, in patients without stress hyperglycemia (both P <0.01). In the baseline LVEDVI and LVESVI was significantly larger in SH group (58.33±8.92 vs 54.17±8.98 ml/m2,P<0.05, 29.14±7.61 vs 24.67±5.96 ml/m2,P<0.01 ), but LVEF obviously lower (50.49±6.98 vs 54.54±7.09,P <0.05);at 3 months LVEDVI and LVESVI was significantly larger in SH group (62.73±9.95 vs 56.90±9.29 ml/m2,P<0.01, 31.08±8.03 vs 25.58±5.93 ml/m2,P<0.001 ) , but LVEF was obviously lower (50.89±6.54 vs 55.08±7.10 , P<0.01) and the incidence of major adverse cardiovascular events were significantly higher than the non-SH group (31.58% vs 19.05%, P<0.05). There was a significant negative correlation between plasma concentration of adiponectin and blood glucose level (r= -0.415 ,P<0.01). The plasma concentration of adiponectin was also negatively correlated with the diameter of LVEDVI and LVESVI changed in 3 months (r=-0.363,P<0.01 ; r=-0.344,P<0.05). The changes in LVEDVI and LVESVI was positively correlated with blood glucose level (r=0.338,P<0.01;r=0.383,P<0.01). There were no significant difference between the two groups in age, gender, blood pressure, Body mass index, blood lipid level, CK-MB peak value, Treatment Method and so on .Conclusion: 1 In patients with ACS, plasma adiponectin level in stress hyperglycemia group was significantly lower than in non-stress hyperglycemia group, and Linear correlation analysis showed there was a significant negative correlation between blood glucose level and plasma adiponectin level. It seemed that stress status also had effect on plasma adiponectin level in patients with ACS.2 Compared with non-stress hyperglycemia group, the occurrence of MACE in stress hyperglycemia group was significantly higher, and there was a closely correlation between blood glucose level and left ventricular remodeling. It demonstrated that the hyperglycemia was a negative factor which leaded to the occurrence of MACE and left ventricular remodeling increased.3 The Plasma adiponectin level was closely related with left ventricular remodeling and adverse outcome in patients with ACS. These results suggested that the stress status might lead to plasma adiponectin level of ACS patients decreased, and further lead to left ventricular remodeling and occurrence of adverse events.