A European observational study has determined that 2h post-load glucose (2-hPG) is a better marker than HbA1c in predicting cardiovascular events for coronary artery disease patients. This study was conducted in various European countries and was published in the Lancet Diabetes Endocrinology in Sept 2024. Coronary artery disease is a condition where fat, cholesterol and other materials get deposited in the blood vessels leading to the heart causing blockage and increasing the risk of heart attack, failure, or stroke. 2-hPG is measured by an oral glucose tolerance test (OGTT). For the test, the patients are fasted for 10 hours and blood is drawn to measure fasting blood glucose. Next, they drink 75 g glucose in 200 ml of water, and blood is drawn after 2 hours to measure 2-hPG.
Study population
This observational study used data from EUROASPIRE (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) IV and V (EAIV and EAV), performed in 2012-13 and 2016-17 respectively. EAIV was conducted in 79 centers across 24 European countries and EAV in 131 centers across 27 European countries. EAIV and EAV recruited patients, who had coronary artery disease for 6-36 months or 6-24 months, respectively but no diabetes. There were 16,259 patients in both cohorts. 8364 patients had both OGTT and HbA1c data. The cardiovascular events in these patients were determined by a questionnaire at least 1 year after the baseline measurements. 7892 patients had follow-up data, with a median follow-up of 1.6 years. The majority (~75%) of the patients were men with an average age of about 63.3 years. Most of the patients were on some cardioprotective drug.
Outcome
Out of 8263 patients, 22.5% were found to have newly developed type 2 diabetes based on 2-hPG (≥ 200mg/dL) and 4.2% using HbA1c. The sensitivity and specificity of HbA1c were 12% and 98%, respectively when the threshold was 6.5%. When the threshold was 5.7%, its sensitivity and specificity were 68% and 62%, respectively, and diagnosed 44.8% of patients with diabetes. Thus, it mistakenly detected more patients with diabetes.
Based on the cardiovascular events in 7892 patients, 2-hPG was the most reliable marker to predict future adverse events, but not HbA1c. Moreover, adding either HbA1c or fasting blood glucose information to 2-hPG did not improve its predictive value.
Limitations
- The results were based on single OGTT and HbA1c values, which might have introduced some errors.
- A significant number of people was not considered in the analysis which might have introduced some bias.
- More than 90% of the patients were White. Thus, the cutoff observed here could be different for other ethnic groups.
- This study focused only on coronary artery disease; thus, the outcome cannot be generalized to other disease groups.
- Lastly, the follow-up time was relatively short, and the long-term impact of high glucose is not measured here.
Dr. Vinny Negi, Ph.D.
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