European Heart Journal Advance Access originally published online on February 15, 2005
European Heart Journal 2005 26(6):623-624; doi:10.1093/eurheartj/ehi134
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Oral glucose tolerance test or metabolic syndrome criteria to predict risk in patients with coronary heart disease?: reply
Department of Cardiology
Karolinska University Hospital Solne
17176 Stockholm, Sweden
Tel: +46 8 517 70461
Fax: +46 8 31 10 44
E-mail address: malgorzata.bartnik{at}medks.ki.se
E-mail address: lars.ryden{at}medks.ki.se
We are grateful for your interest in our article and your comments are indeed valid and important. Abnormal glucose metabolism is part of the metabolic syndrome as an optional or necessary component depending on the definition by the US National Cholesterol Education Program (NCEP) Adult Treatment Panel III or World Health Organization.1 The main objective of our report was to study the hypothesis that abnormal glucose tolerance newly detected soon after the onset of a myocardial infarction has a negative prognostic impact.
Regarding the reproducibility of an oral glucose tolerance test (OGTT), it is known that any categorization based on continuous measurements is a simplification undertaken to facilitate assessment, in this case individual risk. The reproducibility of an OGTT classification into three categories, normal, abnormal glucose tolerance, or diabetes, was similar to classification based on fasting blood glucose.2 Various epidemiological data showed that the outcome of a single abnormal OGTT is a powerful indicator of future cardiovascular and all-cause mortality. It should be underlined that there is no reason for considering whether the OGTT results are influenced by beta-blockers or diuretics, while assessing patients with coronary artery disease for whom such medication may be mandatory.
All components of the metabolic syndrome (hypertension, body mass index, triglycerides, HDL-cholesterol, microalbuminuria, fasting, and post-load blood glucose) were among other variables tested for their potential association with the incidence of major cardiovascular events.3 According to a Cox regression analysis abnormal glucose tolerance (P=0.008), fasting blood glucose (day 2, P=0.081), and post-load glucose (P=0.087) were the only variables reaching statistical significance (P<0.20).3
In our opinion, testing whether the metabolic syndrome, based on these elements, could be significantly related to the incidence of major cardiovascular events did not appear meaningful.
According to your suggestion we performed classification of the metabolic syndrome according to the NCEP, as described by Dr Olijhoek, and the World Health Organization.1 According to these criteria, 177 (NCEP) or 169 (WHO) out of 181 patients could be classified of whom 53 or 44%, respectively, had a metabolic syndrome. The presence of the metabolic syndrome did not, however, relate to future events.
The metabolic syndrome is associated with development of cardiovascular disease and type 2 diabetes but may be less important for subsequent cardiovascular events among patients with established coronary artery disease than observed in the general population.4
Most recently, several potential benefits of oral glucose load testing have been recognized in a joint report of the US National Heart, Lung, and Blood Institute and the American Heart Association.5 Abnormal glucose tolerance detected by an OGTT, despite its limitations, conveys important prognostic information not disclosed by other risk factors or measurements. The use of an OGTT is therefore recommended to identify patients at risk for major cardiovascular endpoints, who would not be recognized by means of other commonly used risk factors. An OGTT will improve the assessment of total cardiovascular risk in patients after a myocardial infarction.
References
- Report of the WHO Consultation. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1 Diagnosis and classification of diabetes mellitus. World Health Organization, Department of Noncommunicable Disease Surveillance, Geneva 1999. http://www.idi.org.au/downloads/who_report.pdf.
- Ko GTC, Chan JCN, Woo J, Lau E, Yeung VTF, Chow C-C, Cockram CS. The reproducibility and usefulness of the oral glucose tolerance test in screening for diabetes and other cardiovascular risk factors. Ann Clin Biochem 1998;35:62–67.
- Bartnik M, Malmberg K, Norhammar A, Tenerz A°, Öhrvik J, Rydén 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] - Andersson JL, Horne BD, Jones HU, Reyna SP, Carlquist JF, Bair TL, Person RR, Lappé DL, Muhlestein JB for the Intermountain Heart Collaborative (IHC) Study Group. Which features of the metabolic syndrome predict the prevalence and clinical outcomes of angiographic coronary artery disease? Cardiology 2004;101:185–193.[CrossRef][Web of Science][Medline]
- Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant C for the Conference Participants. Definition of the metabolic syndrome. Report of the National Heart Lung, and Blood Institute/American Heart Association Conference on scientific issues related to definition. Circulation 2004;109:433–438.
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