Abstract
Background
Only few data on the prevalence of DM in young patients with ST-elevation myocardial infarction (STEMI) exist. Aim of the present study was to analyse this prevalence, its association to other cardiovascular risk factors and its impact on severity of CAD. In a substudy, consecutive HbA1c measurements in each patient were evaluated.
Methods
All patients ≤ 45 years old, admitted with STEMI to an overregional German Heart Centre and treated with primary coronary intervention between 2006 and 2019, entered analysis. Since 2015 HbA1c measurements were performed to detect unknown dysglycaemia.
Results
Out of 776 young patients of the total cohort, 88 patients (11.4%) had a DM, while 688 (88.6%) did not. Diabetics were more likely to be obese (BMI ≥ 30 kg/m2, OR 2.4, 95%CI 1.4–4.0, p < 0.01) and very obese (BMI ≥ 40 kg/m2, OR 5.1, 95%CI 2.1–12.2, p < 0.01). In diabetics, a higher likelihood of subacute STEMI (OR 2.2, 95% CI 1.1–4.5, p < 0.05) and more advanced CAD (OR 1.6, 95% CI 1.0–2.6, p < 0.05) compared to non-diabetics was observed. 208 patients were included in the substudy with HbA1c measurements. Out of those, 26 patients (12%) had known DM, while 17 patients (8%) had newly diagnosed DM and 49 patients (24%) preDM. The combined prevalence of any type of dysglycaemia was 44%.
Conclusion
DM in young patients with STEMI was associated with (severe) obesity, a higher likelihood of subacute STEMI and more advanced CAD compared to non-diabetics. Measurement of HbA1c in every consecutive STEMI-patient increased the rate of detected dysglycaemias more than three times higher than in general population.
Graphic abstract
Similar content being viewed by others
References
O’Donnell CJ, Elosua R (2008) Cardiovascular risk factors. Insights from Framingham Heart Study. Rev Esp Cardiol 61:299–310
Jacobs E, Hoyer A, Brinks R, Kuss O, Rathmann W (2017) Burden of mortality attributable to diagnosed diabetes: a nationwide analysis based on claims data from 65 million people in Germany. Diabetes Care 40:1703–1709
Shah N, Kelly AM, Cox N, Wong C, Soon K (2016) Myocardial infarction in the “young”: risk factors, presentation, management and prognosis. Heart Lung Circ 25:955–960
World Health Organisation (2016) Global burden on diabetes. In: Library cataloguing-in-publication date, pp 1–88
Tönnies T, Röckl S, Hoyer A, Heidemann C, Baumert J, Du Y, Scheidt-Nave C, Brinks R (2019) Projected number of people with diagnosed Type 2 diabetes in Germany in 2040. Diabet Med 36:1217–1225
Jacobs E, Rathmann W, Tönnies T, Arendt D, Marchowez M, Veith L, Kuss O, Brinks R, Hoyer A (2029) Age at diagnosis of Type 2 diabetes in Germany: a nationwide analysis based on claims data from 69 million people. Diabet Med 37:1723–1727
Luk A, Ke C, Lau E, Wu H, Goggins W, Ma R, Chow E, Kong A, So WJ, Chan J (2020) Secular trends in incidence of type 1 and type 2 diabetes in Hong Kong: a retrospective cohort study. PLoS Med 17:e1003052
Vistisen D, Witte D, Brunner E, Kivimäki M, Tabák A, Jørgensen M, Færch M (2018) Risk of cardiovascular disease and death in individuals with prediabetes defined by different criteria: the Whitehall II study. Diabetes Care 41:899–906
Ibanez B, James S, Agewall S et al (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force on the management acute myocardial infarction in patients presenting with ST-segment elevation of the ESC. Eur Heart J 39:119–177
Steg G, James S, Atar D et al (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33:2569–2619
Zeymer U, Kastrati A, Rassaf T, Scholz K-H, Thiele H (2012) ESC Pocket Guidelines Therapie des akuten Herzinfarktes bei Patienten mit persistierender ST-Streckenhebung. Update 2012 Düsseldorf: Deutsche Gesellschaft für Kardiologie
American Diabetes Association (2020) 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2020. Diabetes Care 43:S14–S31
IDF Diabetes Atlas 2019 (2019) International Diabetes Federation, 9th edn. ISBN: 978-2-930229-87-4
Pulgaron E, Delamater A (2014) Obesity and type 2 diabetes in children: epidemiology and treatment. Curr Diab Rep 14:508
Schmucker J, Seide S, Wienbergen H, Fiehn E, Stehmeier J, Günther K, Ahrens W, Hambrecht R, Pohlabeln H, Fach A (2017) Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis. BMC Cardiovasc Disord 17:254
Malone J, Hansen B (2019) Does obesity cause type 2 diabetes mellitus (T2DM)? Or is it the opposite? Pediatr Diabetes 20:5–9
Goraya TY, Leibson CL, Palumbo PJ, Weston SA, Killian JM, Pfeifer EA, Jacobsen SJ, Frye RL, Roger VL (2002) Coronary atherosclerosis in diabetes mellitus—a population-based autopsy study. J Am Coll Cardiol 40:946–953
Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M (1998) Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 339:229–234
Mehta RH, Milford-Beland S, Peterson ED, Bhatt DL, Farkouh ME, Brogan GX, Gibler WB, Ohman M, Roe MT (2007) Characterizing young patients with diabetes and non-ST-segment elevation acute coronary syndromes. Diabetes Care 30:731–733
McNair P, Bilchick K, Keeley E (2019) Very late presentation in ST elevation myocardial infarction: predictors and long-term mortality. IJC Heart Vasc 22:156–159
Donahoe SM, Stewart GC, McCabe CH, Mohanavelu S, Murphy SA, Cannon CP, Antman EM (2007) Diabetes and mortality following acute coronary syndromes. JAMA 298:765–775
Chandrasekhar J, Dangas G, Baber U, Sartori S, Qadeer A, Aquino M, Vogel B, Faggioni M, Vijay P, Claeseen BE, Goel R, Moreno P, Krishnan P, Kovacic JC, Kini A, Mehran R, Sharma S (2020) Impact of insulin treated and non-insulin-treated diabetes compared to patients without diabetes on 1-year outcomes following contemporary PCI. Catheter Cardiovasc Interv 96:298–308
Malmberg K, Båvenholm P, Hamsten A (1994) Clinical and biochemical factors associated with prognosis after myocardial infarction at a young age. J Am Coll Cardiol 24:592–599
Orellana-Barrios M, Fires J, Nugent K, Shurmur S (2019) Glycated hemoglobin, admission blood glucose delta, and associated mortality in patients with acute ST-segment elevation myocardial infarction. Proc (Bayl Univ Med Cent) 32:325–330
Baydar O, Kilic A (2020) Acute hyperglycemia and contrast-induced nephropathy in patients with non-ST elevation myocardial infarction. Cardiovasc Endocrinol Metab 9:24–29
Khalfallah M, Abdelmageed R, Elgendy E, Hafez YM (2020) Incidence, predictors and outcomes of stress hyperglycemia in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Diab Vasc Dis Res 17:1479164119883983
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Mata Marín, L.A., Schmucker, J., Fach, A. et al. Prevalence and clinical characteristics of prediabetes and diabetes mellitus in young patients with ST-segment elevation myocardial infarction. Clin Res Cardiol 110, 1647–1658 (2021). https://doi.org/10.1007/s00392-021-01868-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-021-01868-1