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- Nilsson, Göran, et al.
(author)
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Waist circumference alone predicts insulin resistance as good as the metabolic syndrome in elderly women
- 2008
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In: European journal of internal medicine. - : Elsevier BV. - 0953-6205 .- 1879-0828. ; 19:7, s. 520-526
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Journal article (peer-reviewed)abstract
- Background: Insulin resistance (IR) is a risk factor for diabetes and atherosclerotic diseases. The metabolic syndrome (MetS) reflects IR. Waist circumference (WC) is the most easily registered component of MetS. The objective was to compare WC alone with MetS as defined by the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (W) for their abilities to predict IR in elderly without known diabetes. Methods: The study included 223 women and 2 10 men comprising 70% of a random sample of 75-year-olds from a general population. IR was conventionally defined as the gender-specific upper quartile of the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) index in individuals without known diabetes. Results: 1) The positive association between WC and IR is stronger in women than in men. 2) WC > 88 cm alone is nearly as good as MetS, using NCEP criteria, in predicting IR in women. 3) According to the ROC curve, the optimal cut-off point for WC predicting IR was between 96 and 97 cm (men) and between 88 and 89 cm (women). The relative risk of IR was 5.6 (95% CI: 3.1-11.9) for women with WC > 88 cm and 1.9 (1.5-2.8) for men with WC > 96 cm. 4) The NCEP criteria predicts IR significantly better than the IDF criteria. Conclusion: WC > 88 cm in women indicates a high likelihood of IR and is almost as good as MetS defined using the NCEP criteria in predicting IR. MetS defined using the NCEP criteria predicts IR better than MetS defined using the IDF criteria. (C) 2008 European Federation of internal Medicine. Published by Elsevier B.V. All rights reserved.
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- Tenerz, Åke, et al.
(author)
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Basal glucometabolic status has an impact on long-term prognosis following an acute myocardial infarction in non-diabetic patients
- 2003
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In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 254, s. 494-
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Journal article (peer-reviewed)abstract
- OBJECTIVES: Patients with diabetes are known to have a worse prognosis after an acute myocardial infarction (AMI) compared with non-diabetic patients. The primary aim of this study was to investigate the effect of glucometabolic status on long-term prognosis in non-diabetic patients with an AMI. The second aim was to evaluate the extent to which blood glucose levels at admission depended on acute stress, assessed as serum cortisol, previous glucometabolic status, measured as haemoglobin A1c (HbA1c), or both.DESIGN: In a prospective study of patients with an AMI, blood glucose, HbA1c and cortisol were measured at admission. Fasting blood glucose was determined before discharge and also afterwards, if necessary, for classification. Patients were followed-up for 5.5 years.SUBJECTS: Of the 305 consecutive patients 24% were diagnosed as diabetic and 76% as non-diabetic.MAIN OUTCOME MEASURES: Death or non-fatal myocardial re-infarction.RESULTS: In non-diabetic patients, a Cox regression model was used. With death or re-infarction as endpoint, the following prognostic factors had an impact on event-free survival: age (P<0.001), HbA1c (P=0.002), cortisol (P<0.001) and thrombolytic treatment (P=0.001). There was a correlation between cortisol and blood glucose at admission (r=0.44, P<0.001). Fasting blood glucose day 5 showed no association with event-free survival.CONCLUSIONS: In non-diabetic patients with AMI, admission HbA1c and cortisol were predictors for 5.5-year survival without recurrent non-fatal myocardial infarction. The glucometabolic status of importance for prognosis was detected by HbA1c but not by fasting blood glucose or admission blood glucose, of which the latter was influenced by cortisol.
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