Performance of DPP-4-inhhibitors versus sulfonylureas on top of metformin in a real world setting - results of 2 years FU of DiaRegis

A. K. Gitt, P. Bramlage, S. Schneider, R. Zahn, C. Binz, M. Krekler, D. Tschoepe
2013 European Heart Journal  
Although acute hyperglycemia, including postprandial hyperglycemia, attenuates vascular endothelial function independent of diabetes mellitus (DM), clinical implication of changes in coronary flow reserve (CFR) during acute hyperglycemia remains unclear. This present study was conducted to evaluate the significance of changes in CFR during acute hyperglycemia as a long-term predictor of acute coronary syndrome (ACS) in patients without DM. Methods: Using transthoracic Doppler echocardiography,
more » ... e analyzed change in CFR before and 1 hour after an oral glucose loading in 62 non-DM patients (mean age: 58 years) during the periods of 2002 to 2004. HbA1C of all patients were less than 6.5%. CFR measurement was performed at the left anterior descending coronary artery or right coronary artery as the target vessels without any significant coronary stenosis. Patients with valvular disease, atrial fibrillation, artificial pacemaker, coronary artery bypass grafting, significant left ventricular (LV) hypertrophy, and chronic kidney disease (serum creatinine >1.5 mg/dl) were excluded. Cox proportional hazards models were used to assess the risk of ACS caused by vascular events on the target vessels with adjustments for age, gender, use of anti-hypertensive medicines, use of statin, history of coronary intervension for the non-target vessels, body mass index, smoking, HbA1C, HOMA-R assessing insulin resistance. Results: During a mean of 7.3 years of follow-up, 7 ACS (11.2%) occurred. CFR before a glucose loading (b-CFR: p=0.03, HR=0.18, 95% CI 0.04-0.86) and CFR after a glucose loading (a-CFR: p=0.01, HR=0.08: 95% CI 0.01-0.60) were significantly associated with incidence of ACS, but a change in CFR was not. Although b-CFR was significantly associated with incidence of ACS after adjusting age and gender (model 1), its association was not observed by adding a use of anti-hypertensive medicines, a use of statin, and a history of coronary intervention (model 2). On the other hand, a-CFR was associated with incidence of ACS in the model 1 (p=0.01, HR=0.09, 95% CI 0.01-0.56) and model 2 (p=0.05, HR=0.10, 95% CI 0.01-1.06). In addition, its association was preserved after adding body mass index, smoking, HbA1C, and HOMA-R (model 3: p=0.03, HR=0.004, 95% CI 0.00-0.65), and b-CFR (model 4: p=0.048, HR=0.003, 95% CI 0.00-0.95). Conclusions: CFR after a glucose loading was an independent predictor for ACS on the target coronary artery amongst non-DM individuals. Impairment of CFR after acute hyperglycemia might be a strong predictor of coronary events on the target vessels.
doi:10.1093/eurheartj/eht311.5928 fatcat:gspxuwdflfebjk2hkoxffcnftm