Prevalence and prognostic significance of chronic hyperglycaemia post acute myocardial infarction in a multiethnic UK population

• Main Author: Gholap, Nitin Narayan
• Other Authors: Khunti, Kamlesh ; Davies, Melanie
• Published: University of Leicester 2017
• Subjects: 610
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.727442

Background: Coronary heart disease (CHD) and chronic hyperglycaemia (type 2 diabetes (T2DM) and impaired glucose regulation) are highly prevalent and associated with premature and excess mortality in the South Asian (SA) compared with the White European (WE) population. Further knowledge about chronic hyperglycaemia in SA patients with acute myocardial infarction (AMI) would help develop strategies to reduce the burden of CHD in this ethnic group. Aims: 1) To undertake a systematic review and meta-analysis to establish the association between diabetes and long-term mortality post AMI. 2) To investigate the relative prognostic significance of admission hyperglycaemia and prior diabetes in SA and WE patients admitted with AMI. 3) To compare survival in SA and WE patients presenting with AMI 4) To compare the prevalence of undiagnosed chronic hyperglycaemia in SA and WE patients admitted with AMI. 5) To evaluate the diagnostic yield and utility of oral glucose tolerance test (OGTT) versus HbA1c in screening for chronic hyperglycaemia in AMI. Key findings: 1) Diabetes increased long-term mortality post AMI by 50%. 2) Admission glucose was strongly associated with short- and long-term mortality post AMI, irrespective of prior diabetes diagnosis. 3) Adjusted survival following AMI was similar for SA and WE patients in the UK. 4) SA patients with AMI had up to six-fold higher risk of having undiagnosed T2DM than WE patients. 5) In AMI, use of HBA1c increased the prevalence of undiagnosed T2DM by over 1.5 fold (6.0% to 8.5%) in comparison with OGTT. Conclusion: This thesis established the higher prevalence of T2DM (diagnosed and undiagnosed) in UK SA patients presenting with AMI. This programme of work will help establish methods of screening for chronic hyperglycaemia in the setting of AMI. Early detection of T2DM in the SA population is extremely important to curb the higher incidence of CHD and related mortality in this population.