Age influences glucose handling in acute phase of STEMI
MedWire News: Older patients have higher glucose levels and worse glycemic control in the early phase of ST-elevation myocardial infarction (STEMI) than younger patients, although insulin resistance does not vary by age, Italian researchers have shown.
The findings suggest that elderly STEMI patients without known diabetes represent a high-risk subgroup that may benefit from a more aggressive therapeutic regimen.
Chiara Lazzeri (Universitaria Careggi, Florence, Italy) and colleagues investigated the influence of age on glucose handling among 346 consecutive patients with STEMI. All had undergone primary percutaneous coronary intervention before being admitted to an intensive coronary care unit (ICCU).
When participants were stratified by age, the oldest group (those aged 79 years and above) had the lowest left ventricular ejection fraction, the highest incidence of two- and three-vessel coronary artery disease, and the highest in-hospital mortality.
Laboratory parameters also differed by age, with fibrinogen, N-terminal pro-B-type natriuretic peptide, and erythrocyte sedimentation rate all being highest among the oldest patients.
Interestingly, the oldest patients had the highest values for fasting glycemia and peak glycemia, at 1.46 and 1.77 g/l, respectively, compared with 1.20 and 1.36 g/l, respectively, in those aged 59 years and below. Meanwhile, insulin resistance (as inferred from the homeostasis model assessment) was unchanged across the age subgroups.
In an exploratory analysis, the authors excluded patents with poor glycemic control in the 2–3 months before STEMI, as indicated by glycated hemoglobin levels above 6.5%. Again, the very oldest patients had the highest glycemia values whereas insulin resistance was unchanged.
Finally, in stepwise regression analysis, age was the only significant independent predictor for in-hospital death.
“In the acute phase of STEMI acute glucose metabolism appears to be affected by age, since older patients showed the highest glucose levels and the poorest glycemic control during ICCU stay despite the lack of differences in insulin resistance incidence,” Lazzeri and co-authors conclude.
“Further studies are warranted to establish whether a different (more aggressive) therapeutic regime is needed in this subgroup of patients at higher risk.”
The study appears in the journal Diabetes and Vascular Disease Research.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Joanna Lyford