European Heart Journal Advance Access originally published online on February 15, 2005
European Heart Journal 2005 26(6):623; doi:10.1093/eurheartj/ehi133
Oral glucose tolerance test or metabolic syndrome criteria to predict risk in patients with coronary heart disease?
Internal Medicine Section of Vascular Medicine
University Medical Centre Utrecht
F02.126, Heidelberglaan 100
3584 CX Utrecht, The Netherlands
Tel: +31 30 250 9111
Fax: +31 30 251 8328
E-mail address: J.K.Olijhoek{at}umcutrecht.nl
Internal Medicine
Section of Vascular Medicine
University Medical Centre Utrecht
The Netherlands
Department of Cardiology
Heart Lung Centre
University Medical Centre Utrecht
The Netherlands
Internal Medicine
Section of Vascular Medicine
University Medical Centre Utrecht
The Netherlands
With great interest we read the article by Bartnik et al.,1 which investigated the predictive value of newly detected abnormal glucose tolerance, as assessed by oral glucose tolerance test (OGTT), on the long-term outcome after myocardial infarction. This is a remarkable finding, given the poor reproducibility of the OGTT.2 This test should be performed under standardized conditions, which require a diet containing more than 150 g of carbohydrate daily during the 3 days before the test, a reasonable (30–50 g) carbohydrate-containing meal the evening before the test, and one needs to allow for factors that could influence the glucometabolic state, e.g. certain medications (diuretics, salicylates, and sympathomimetics), inactivity, and infection. We would think that identification of the metabolic syndrome, as an estimate of abnormal glucose metabolism, is a simpler method of estimating increased cardiovascular risk. The metabolic syndrome is a cluster of cardiovascular risk factors and is associated with an increased risk for cardiovascular morbidity and mortality and for the development of type 2 diabetes. According to the definition proposed by the US NCEP (National Cholesterol Education Program),3 the metabolic syndrome can be identified if three or more of the following metabolic abnormalities are present: waist circumference >102 cm in men and >88 cm in women, blood pressure 
130 mmHg systolic or 85 mmHg diastolic, serum triglycerides 1.70 mmol/L, serum HDL-cholesterol <1.04 mmol/L in men and <1.29 mmol/L in women, and fasting serum glucose 6.1 mmol/L. Since waist circumference is not always available, a widely accepted method is to substitute body mass index.
In patients with coronary heart disease, the metabolic syndrome is indeed highly prevalent (41%)4 and associated with increased cardiovascular risk.5 Besides this, according to a recently published report of the NCEP, the presence of the metabolic syndrome indicates very high risk for patients with coronary artery disease. For these patients it should be considered to lower the therapeutic goal of LDL-lowering therapy to 1.8 mmol/L instead of 2.6 mmol/L.6 It would be valuable to the scientific community to be informed about the presence and predictive value of the metabolic syndrome in the study population described by Bartnik et al.,1 as they have near complete data including blood pressure, glucose, HDL-cholesterol, and triglyceride levels to enable them to do so.
Impaired glucose tolerance seems an important predictor of long-term outcome in patients with coronary heart disease. To detect abnormal glucose metabolism and predict cardiovascular risk for many patients, both in-hospital and in the outpatient clinic setting, an easy to use and practical test is needed. Identifying the metabolic syndrome according to NCEP criteria is such a simple method.
References
- Bartnik M, Malmberg K, Norhammar A, Tenerz, Ohrvik J, Ryden L. Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction. Eur Heart J 2004;25:1990–1997.
[Abstract/Free Full Text] - Mooy JM, Grootenhuis PA, de Vries H, Kostense PJ, Popp-Snijders C, Bouter LM, Heine RJ. Intra-individual variation of glucose, specific insulin and proinsulin concentrations measured by two oral glucose tolerance tests in a general Caucasian population: the Hoorn Study. Diabetologia 1996;39:298–305.[Web of Science][Medline]
- Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486–2497.
[Free Full Text] - Gorter P, Olijhoek JK, Graaf van der Y, Algra A, Rabelink AJ, Visseren FLJ. Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm. Atherosclerosis 2004;173:361–367.[CrossRef]
- Olijhoek JK, van der Graaf Y, Banga JD, Algra A, Rabelink TJ, Visseren FL. The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm. Eur Heart J 2004;25:342–348.
[Abstract/Free Full Text] - Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227–239.
[Abstract/Free Full Text]
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