Effect Of Fasting Blood Glucose Levels On Coronary Heart Disease Prognosis:a Prospective Cohort Study

BackgroundTreatment guidelines for high fasting blood glucose（FBG）levels focus mainly on blood glucose control and lifestyle management to delay the occurrence of cardiovascular events.Few evidence-based strategies are available for improving the prognosis of high FBG levels in patients with coronary heart disease（CHD）.ObjectivesTo investigate the impact of FBG levels on long-term prognosis after coronary angiography（CAG）in CHD patients without diabetes mellitus（DM）history.MethodsWe included 1153 CHD patients without DM history,who underwent CAG and/or PCI from January 2016 to December 2018 at the Hospital.Patients were divided into four groups: level 1（FBG 4.0-5.19 mmol/L）,level 2（FBG 5.20-5.59 mmol/L）,level 3（FBG5.60-6.09 mmol/L）,and level 4（FBG 6.10-6.99 mmol/L）and followed up for 2 years post-discharge,with a primary endpoint of major adverse cardiovascular events（MACE）.Results1 The relationship between fasting glucose level and prognosis of coronary heart disease: 2-year follow-up results showed that the rates of cardiogenic rehospitalization were 15.30%,15.70%,and 15.60% in level 2,level 3,and level 4 patients,respectively,which were significantly higher than those of 9.35% in the level 1 group（P < 0.05）.K-M survival analysis showed that high levels of fasting glucose（level 2,level 3,and level 4） groups had significantly higher rates of cardiogenic rehospitalization than the low-level fasting glucose（level 1）group（P=0.034）2 The results of the COX proportional risk model analysis after correction for confounders（gender,age,etc.）showed a significantly increased risk of cardiac readmission in patients with glucose levels >5.19 mmol/L（level 2 : HR 1.736,95%CI1.072-2.811,P=0.025;level 3:HR 1.753,95% CI 1.018-3.02,P=0.043;level 4:HR 2.011,95% CI 1.135-3.562,P<0.05）.3 Compared to the American Diabetes Association（ADA）and WHO definition of prediabetes,the COX proportional risk model with a cut-off value of 5.20 mmol/L was significantly associated with the risk of cardiac readmission（HR 1.71,95%CI 1.18-2.5,P=0.005）after correction for confounding factors（gender,age,etc.）ConclusionElevated fasting glucose levels are an independent risk factor for cardiogenic readmission after CAG in patients with CHD without a history of diabetes mellitus.5.20mmol/L as a cut-off value compared with different defined cut-off values for prediabetes may be more useful for early intervention to improve the prognosis of patients with CHD.