Gender features of changes in clinical and laboratory indicators in patients with acute Q-myocardial infarction complicated by acute heart failure and hyperglycemia on admission
DOI:
https://doi.org/10.14739/2310-1210.2021.2.228704Keywords:
myocardial infarction, heart failure, patient gender, hyperglycemia, glycemic profile, lipid profileAbstract
The aim was to determine the gender characteristics of changes in the levels of heart failure markers, neurohumoral stress and blood biochemical parameters in patients with acute Q-myocardial infarction (Q-MI) complicated by acute heart failure (AHF) and hyperglycemia (HG) on admission.
Materials and methods. The study involved 84 patients with Q-MI complicated by AHF and HG on admission without a history of diabetes. The average age was 67.00 ± 1.34 years (M ± m). The patients were divided into 2 groups based on gender. Male patients made up the 1 group (n = 52), the mean age was 63.00 ± 1.56 years (M ± m). Group 2 (n = 32) included female patients, the mean age was 78.00 ± 1.81 years. The patients underwent measurements of admission blood glucose level, average glycemia during the first day, glycemic profile (GP) variability, the level of copeptin, NTproBNP, insulin, lipid profile, coagulogram, blood electrolytes, and HOMA index was calculated. On the 12th day, the patients were further examined in order to determine the cause of the HG development.
Results. Men had a significantly higher level of standard deviation of HP by 33 %, and average glycemia during the first day by 14 %. There was a tendency towards higher levels of insulin and HOMA-index in male patients compared with women (2.2 times and 1.95 times, respectively). In women, the level of copeptin on day 12 was significantly higher than in men by 2.14 times, and NTproBNP by 2.09 times. In men, there was a tendency towards a decrease in these indicators during the acute period of Q-MI, and the levels of markers increased on the 12th day in women. Troponin I levels in male patients was 2 times higher compared to those in women, but not significantly. No significant differences were found in terms of coagulogram indicators. In women, the level of total cholesterol (TC) on day 1 exceeded that in men by 14 %, on day 12 – by 7 %, the level of low density lipoproteins (LDL) on day 1 – by 18 %, on day 12 – by 17 %. In a dynamic follow-up, the level of TC in men significantly decreased by 10 % (P = 0.002), and in women by 16 % (P < 0.001). The LDL level in men decreased by 17 % (P < 0.001), and in women by 18 % (P < 0.001).
Conclusions. The men with acute Q-MI complicated by AHF and HG on admission had significantly higher mean levels of glycemia (by 14 %) and standard deviation of HF during the first day of treatment (by 33 %) as compared to women, and also they showed the tendency to higher levels of troponin I, insulin and HOMA index. Female patients with acute Q-MI complicated by AHF and HG on admission, were found to have significantly higher levels of copeptin (2.14 times) and NTproBNP (2.09 times) on day 12, higher levels of TC and LDL on day 1 (GC by 14 %, LDL by 18 %) and on day 12 (GC by 7 %, LDL by 17 %), but they had better dynamics of the decrease in lipid profile indicators during treatment compared with that in men. Coagulogram indices did not differ significantly depending on the patient gender.
References
Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Blaha, M. J., Dai, S., Ford, E. S., Fox, C. S., Franco, S., Fullerton, H. J., Gillespie, C., Hailpern, S. M., Heit, J. A., Howard, V. J., Huffman, M. D., Judd, S. E., Kissela, B. M., Kittner, S. J., Lackland, D. T., … American Heart Association Statistics Committee and Stroke Statistics Subcommittee. (2014). Heart Disease and Stroke Statistics - 2014 Update: A Report From the American Heart Association. Circulation, 129(3), e28-e292. https://doi.org/10.1161/01.cir.0000441139.02102.80
Kytö, V., Sipilä, J., & Rautava, P. (2015). Gender and In-hospital Mortality of ST-Segment Elevation Myocardial Infarction (from a Multihospital Nationwide Registry Study of 31,689 Patients). American Journal of Cardiology, 115(3), 303-306. https://doi.org/10.1016/j.amjcard.2014.11.001
Lawesson, S. S., Alfredsson, J., Fredrikson, M., & Swahn, E. (2012). Time trends in STEMI - improved treatment and outcome but still a gender gap: a prospective observational cohort study from the SWEDEHEART register. BMJ Open, 2(2), Article e000726. https://doi.org/10.1136/bmjopen-2011-000726
Cinar, H., Avci, A., Gulen, M., Avci, B. S., Comertpay, E., & Satar, S. (2019). Does stress hyperglycemia affect mortality? Acute myocardial infarction - case control study. Archives of Medical Science - Atherosclerotic Diseases, 4, e201-e207. https://doi.org/10.5114/amsad.2019.87303
WHO, & IDF. (2006). Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia. Report of a WHO/IDF consultation. World Health Organization. https://www.who.int/diabetes/publications/diagnosis_diabetes2006/en/
Ministry of Health of Ukraine. (2014, July 02). Pro zatverdzhennia ta vprovadzhennia medyko-tekhnolohichnykh dokumentiv zi standartyzatsii medychnoi dopomohy pry hostromu koronarnomu syndromi z elevatsiieiu sehmenta ST [On approval and adoption of medical and technological documents on standardization of medical care for ST-segment elevation acute coronary syndrome (No. 455)]. https://zakon.rada.gov.ua/rada/show/v0455282-14#n17
Moghissi, E. S., Korytkowski, M. T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I. B., Inzucchi, S E., Ismail-Beigi, F., Kirkman, M. S., Umpierrez, G. E., American Association of Clinical Endocrinologists, & American Diabetes Association. (2009). American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care, 32(6), 1119-1131. https://doi.org/10.2337/dc09-9029
Tylee, T. S., & Trence, D. L. (2012). Glycemic Variability: Looking Beyond the A1C. Diabetes Spectrum, 25(3), 149-153. https://doi.org/10.2337/diaspect.25.3.149
Ten Haaf, M. E., Bax, M., Ten Berg, J. M., Brouwer, J., Van't Hof, A. W., van der Schaaf, R. J., Stella, P. R., Tjon Joe Gin, R. M., Tonino, P. A., de Vries, A. G., Zijlstra, F., Boersma, E., & Appelman, Y. (2019). Sex differences in characteristics and outcome in acute coronary syndrome patients in the Netherlands. Netherlands Heart Journal, 27(5), 263-271. https://doi.org/10.1007/s12471-019-1271-0
Smaradottir, M. I., Ritsinger, V., Gyberg, V., Norhammar, A., Näsman, P., & Mellbin, L. G. (2017). Copeptin in patients with acute myocardial infarction and newly detected glucose abnormalities - A marker of increased stress susceptibility? A report from the Glucose in Acute Myocardial Infarction cohort. Diabetes & Vascular Disease Research, 14(2), 69-76. https://doi.org/10.1177/1479164116664490
Ay, M. O., Erenler, A. K., Dogan, T., & Yetim, M. (2017). Diagnostic value of copeptin in acute myocardial infarction. European Review for Medical and Pharmacological Sciences, 21(7), 1576-1582.
O'Malley, R. G., Bonaca, M. P., Scirica, B. M., Murphy, S. A., Jarolim, P., Sabatine, M. S., Braunwald, E., & Morrow, D. A. (2014). Prognostic Performance of Multiple Biomarkers in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome: Analysis From the MERLIN-TIMI 36 Trial (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes-Thrombolysis In Myocardial Infarction 36). Journal of the American College of Cardiology, 63(16), 1644-1653. https://doi.org/10.1016/j.jacc.2013.12.034
Ananth, V., Beig, J. R., Tramboo, N. A., Rasool, R., Choh, N. A., Bashir, S., Rather, H. A., & Lone, A. A. (2016). Does plasma copeptin level at admission predict final infarct size in ST-elevation myocardial infarction. International Journal of Cardiology, 219, 326-330. https://doi.org/10.1016/j.ijcard.2016.06.025
Iermak, A. S., Kravchun, P. G., & Rindina, N. G. (2015). Prognosticheskaya tsennost' kopeptina i MRproADM v otnoshenii retsidiva ostrogo infarkta miokarda u bol'nykh s ozhireniem [Copeptin’s and MRproADM’s predictive value in relation of recurrence of acute myocardial infarction in patients with obesity]. Meditsina, (2), 24-27. [in Russian].
Zhang, J., Wang, X., Xiao, W., Liu, Y., Wu, H., Ye, P., & Sheng, L. (2019). NT-proBNP is associated with age, gender and glomerular filtration rate in a community-dwelling population. International Journal of Clinical and Experimental Medicine, 12(10), 12220-12227.
Gutierrez, J., Ramirez, G., Rundek, T., & Sacco, R. L. (2012). Statin Therapy in the Prevention of Recurrent Cardiovascular Events: A Sex-Based Meta-analysis. Archives of Internal Medicine, 172(12), 909-919. https://doi.org/10.1001/archinternmed.2012.2145
Murataliev, T. M., Zventsovа, V. K., Radzhapova, Z. T., Kalinicheva, I. V., Zhanyshbekova, N. Zh., Sultan, u. E., & Mukhtarenko, S. Yu. (2018). Vozrastnaya i gendernaya kharakteristika rasprostranennosti dislipidemii sredi zhitelei g. Bishkek [Age and gender characteristics of dyslipidemia prevalence among the Bishkek city residents]. Klinitsist, 12(3-4), 37-44. https://doi.org/10.17650/1818-8338-2019-12-3-4-37-44
Isiksacan, N., Biyik, I., Opan, S., Caglar, F. N. T., Erturk, M., Yazan, S., Kasapoglu, P., Karabulut, D., Kocamaz, N., Yildirim, M. R., Baycan, O. F., Ozalp, B., Karakurt, H., & Akturk, I. F. (2019). Effect of age and gender differences on high-sensitive troponin T measurement in the diagnosis of acute myocardial infarction. Journal of Laboratory Medicine, 43(1), 35-40. https://doi.org/10.1515/labmed-2018-0326
Venetsanos, D., Sederholm Lawesson, S., Alfredsson, J., Janzon, M., Cequier, A., Chettibi, M., Goodman, S. G., Van't Hof, A. W., Montalescot, G., & Swahn, E. (2017). Association between gender and short-term outcome in patients with ST elevation myocardial infraction participating in the international, prospective, randomised Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) trial: a prespecified analysis. BMJ Open, 7(9), Article e015241. https://doi.org/10.1136/bmjopen-2016-015241
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
