Skip to main content
Top
Published in: Cardiovascular Diabetology 1/2003

Open Access 01-12-2003 | Original investigation

Silent myocardial infarction in women with impaired glucose tolerance: The Northern Sweden MONICA study

Authors: Dan Lundblad, Mats Eliasson

Published in: Cardiovascular Diabetology | Issue 1/2003

Login to get access

Abstract

Background

Patients with impaired glucose tolerance (IGT) have an increased risk of cardiovascular disease (CVD) that is independent of traditional risk factors. Hence, slightly elevated glucose levels, even in the non-diabetic range, might be associated with increased macrovascular disease.

Methods

Within the Northern Sweden MONICA project a population survey was performed in 1986. Electrocardiograms (ECG's) were recorded for half of the survey (n = 790) and oral glucose test was carried out in 78 % of those. The association between subjects with ECG's indicating previously unknown myocardial infarction (ukMI), IGT and conventional risk factors were analyzed by logistic regression for men and women separately, adjusting for age, smoking, hypercholesterolemia and hypertension.

Results

Impaired glucose tolerance was significantly more common among women with ukMI, but not in men, compared to the group with normal ECG. In men, no variable was significantly associated with ukMI although the odds ratio (OR) for hypercholesterolemia was of borderline significance, 3.2 (95% confidence interval (CI) 0.9 to 11). The OR of having ukMI was 4.1 (CI 1.1 to 15) in women with IGT compared to women with normal glucose tolerance after multiple adjustment. The OR for hypertension was of borderline significance; 3.3 (CI 0.97 to 11).

Conclusion

We found that IGT was associated with ECG findings indicating silent myocardial infarction in women in a middle-aged general population in northern Sweden. The results persisted even after adjusting for known risk factors.
Literature
1.
go back to reference Eliasson M, Lindahl B, Lundberg V, Stegmayr B: Diabetes and obesity in northern Sweden – ocurrence and risk for stroke and myocardial infarction. Scand J Publ Health. 2003. Eliasson M, Lindahl B, Lundberg V, Stegmayr B: Diabetes and obesity in northern Sweden – ocurrence and risk for stroke and myocardial infarction. Scand J Publ Health. 2003.
2.
go back to reference Lundberg V, Stegmayr B, Asplund K, Eliasson M, Huhtasaari F: Diabetes as a risk factor for myocardial infarction: population and gender perspectives. J Intern Med. 1997, 241: 485-492.CrossRefPubMed Lundberg V, Stegmayr B, Asplund K, Eliasson M, Huhtasaari F: Diabetes as a risk factor for myocardial infarction: population and gender perspectives. J Intern Med. 1997, 241: 485-492.CrossRefPubMed
3.
go back to reference Eliasson M, Lindahl B, Lundberg V, Stegmayr B: No increase in the prevalence of known diabetes between 1986 and 1999 in subjects 25–64 years of age in northern Sweden. Diabet Med. 2002, 19: 874-880. 10.1046/j.1464-5491.2002.00789.x.CrossRefPubMed Eliasson M, Lindahl B, Lundberg V, Stegmayr B: No increase in the prevalence of known diabetes between 1986 and 1999 in subjects 25–64 years of age in northern Sweden. Diabet Med. 2002, 19: 874-880. 10.1046/j.1464-5491.2002.00789.x.CrossRefPubMed
4.
go back to reference The Decode Study Group: Glucose tolerance and cardiovascular mortality. Comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med. 2001, 161: 397-404. 10.1001/archinte.161.3.397.CrossRef The Decode Study Group: Glucose tolerance and cardiovascular mortality. Comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med. 2001, 161: 397-404. 10.1001/archinte.161.3.397.CrossRef
5.
go back to reference Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK: Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes ?. JAMA. 1990, 263: 2893-2898. 10.1001/jama.263.21.2893.CrossRefPubMed Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK: Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes ?. JAMA. 1990, 263: 2893-2898. 10.1001/jama.263.21.2893.CrossRefPubMed
6.
go back to reference Haffner SM: The importance of hyperglycemia in the nonfasting state to the development of cardiovascular disease. Endocr Rev. 1998, 19: 583-592. 10.1210/er.19.5.583.CrossRefPubMed Haffner SM: The importance of hyperglycemia in the nonfasting state to the development of cardiovascular disease. Endocr Rev. 1998, 19: 583-592. 10.1210/er.19.5.583.CrossRefPubMed
7.
go back to reference McKeigue PM, Ferrie JE, Pierpoint T, Marmot MG: Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinemia. Circulation. 1993, 87: 152-161.CrossRefPubMed McKeigue PM, Ferrie JE, Pierpoint T, Marmot MG: Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinemia. Circulation. 1993, 87: 152-161.CrossRefPubMed
8.
go back to reference Pan XR, Hu YH, Li GW, Liu PA, Bennett PH, Howard BV: Impaired glucose tolerance and its relationship to ECG-indicated coronary heart disease and risk factors among Chinese. Da Qing IGT and diabetes study. Diabetes Care. 1993, 16: 150-156.CrossRefPubMed Pan XR, Hu YH, Li GW, Liu PA, Bennett PH, Howard BV: Impaired glucose tolerance and its relationship to ECG-indicated coronary heart disease and risk factors among Chinese. Da Qing IGT and diabetes study. Diabetes Care. 1993, 16: 150-156.CrossRefPubMed
9.
go back to reference Scheidt-Nave C, Barrett-Connor E, Wingard DL: Resting electro-cardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population. Circulation. 1990, 81: 899-906.CrossRefPubMed Scheidt-Nave C, Barrett-Connor E, Wingard DL: Resting electro-cardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population. Circulation. 1990, 81: 899-906.CrossRefPubMed
10.
go back to reference Rewers M, Shetterly SM, Baxter J, Marshall JA, Hamman RF: Prevalence ofcoronary heart disease in subjects with normal and impaired glucose tolerance and non-insulin-dependent diabetes mellitus in a biethnic Colorado population. The San Luis Valley Diabetes Study. Am J Epidemiol. 1992, 135: 1321-1330.PubMed Rewers M, Shetterly SM, Baxter J, Marshall JA, Hamman RF: Prevalence ofcoronary heart disease in subjects with normal and impaired glucose tolerance and non-insulin-dependent diabetes mellitus in a biethnic Colorado population. The San Luis Valley Diabetes Study. Am J Epidemiol. 1992, 135: 1321-1330.PubMed
11.
go back to reference Stamler R, Stamler J, Schoenberger JA, Shekelle RB, Colette P, Shekelle S, Dyer A, Garside D, Wannamaker J: Relationship of glucose tolerance to prevalence of ECG abnormalities and to 5-year mortality from cardiovascular disease: findings of the Chicago Heart Association Detection Project in Industry. J Chronic Dis. 1979, 32: 817-828.CrossRefPubMed Stamler R, Stamler J, Schoenberger JA, Shekelle RB, Colette P, Shekelle S, Dyer A, Garside D, Wannamaker J: Relationship of glucose tolerance to prevalence of ECG abnormalities and to 5-year mortality from cardiovascular disease: findings of the Chicago Heart Association Detection Project in Industry. J Chronic Dis. 1979, 32: 817-828.CrossRefPubMed
12.
go back to reference Kuulasmaa K, Tunstall-Pedoe H, Dobson A, Fortmann S, Sans S, Tolonen H, Evans A, Ferrario M, Tuomilehto J: Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet. 2000, 355: 675-687. 10.1016/S0140-6736(99)11180-2.CrossRefPubMed Kuulasmaa K, Tunstall-Pedoe H, Dobson A, Fortmann S, Sans S, Tolonen H, Evans A, Ferrario M, Tuomilehto J: Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet. 2000, 355: 675-687. 10.1016/S0140-6736(99)11180-2.CrossRefPubMed
13.
go back to reference Asplund K, Huhtasaari F, Lundberg V, Stegmayr B, Wester PO: Trends in cardiovascular risk factors in the Northern Sweden MONICA study: Who are the winners ?. Cardiovasc Risk Factors. 1993, 3: 215-221. Asplund K, Huhtasaari F, Lundberg V, Stegmayr B, Wester PO: Trends in cardiovascular risk factors in the Northern Sweden MONICA study: Who are the winners ?. Cardiovasc Risk Factors. 1993, 3: 215-221.
14.
go back to reference World Health Organisation: Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation Part 1: Diagnosis and classification of diabetes mellitus. WHO/NCD/NCS/99.2, Geneva. 1999 World Health Organisation: Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation Part 1: Diagnosis and classification of diabetes mellitus. WHO/NCD/NCS/99.2, Geneva. 1999
15.
go back to reference Eliasson M, Evrin PE, Lundblad D: Fibrinogen and fibrinolytic variables in relation to anthropometry, lipids and blood pressure. The Northern Sweden MONICA Study. J Clin Epidemiol. 1994, 47: 513-524.CrossRefPubMed Eliasson M, Evrin PE, Lundblad D: Fibrinogen and fibrinolytic variables in relation to anthropometry, lipids and blood pressure. The Northern Sweden MONICA Study. J Clin Epidemiol. 1994, 47: 513-524.CrossRefPubMed
16.
go back to reference Uusitupa M, Pyorala K, Raunio H, Rissanen V, Lampainen E: Sensitivity and specificity of Minnesota Code Q-QS abnormalities in the diagnosis of myocardial infarction verified at autopsy. Am Heart J. 1983, 106: 753-757.CrossRefPubMed Uusitupa M, Pyorala K, Raunio H, Rissanen V, Lampainen E: Sensitivity and specificity of Minnesota Code Q-QS abnormalities in the diagnosis of myocardial infarction verified at autopsy. Am Heart J. 1983, 106: 753-757.CrossRefPubMed
17.
go back to reference Kannel WB, Abbott RD: Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham study. N Engl J Med. 1984, 311: 1144-1147.CrossRefPubMed Kannel WB, Abbott RD: Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham study. N Engl J Med. 1984, 311: 1144-1147.CrossRefPubMed
18.
go back to reference Laitinen O, Kentala E, Leirisalo M: Electrocardiographic findings in patients with connective tissue disease. Scand J Rheumatol. 1978, 7: 193-198.CrossRefPubMed Laitinen O, Kentala E, Leirisalo M: Electrocardiographic findings in patients with connective tissue disease. Scand J Rheumatol. 1978, 7: 193-198.CrossRefPubMed
19.
go back to reference Rutter MK, Parise H, Benjamin EJ, Levy D, Larson MG, Meigs JB, Nesto RW, Wilson PW, Vasan RS: Impact of glucose intolerance and insulin resistance on cardiac structure and function: sex-related differences in the Framingham Heart Study. Circulation. 2003, 107: 448-54. 10.1161/01.CIR.0000045671.62860.98.CrossRefPubMed Rutter MK, Parise H, Benjamin EJ, Levy D, Larson MG, Meigs JB, Nesto RW, Wilson PW, Vasan RS: Impact of glucose intolerance and insulin resistance on cardiac structure and function: sex-related differences in the Framingham Heart Study. Circulation. 2003, 107: 448-54. 10.1161/01.CIR.0000045671.62860.98.CrossRefPubMed
20.
go back to reference Furberg CD, Manolio TA, Psaty BM, Bild DE, Borhani NO, Newman A, Tabatznik B, Rautaharju PM: Major electrocardiographic abnormalities in persons aged 65 years and older (the Cardiovascular Health Study). Cardiovascular Health Study Collaborative Research Group. Am J Cardiol. 1992, 69: 1329-1335.CrossRefPubMed Furberg CD, Manolio TA, Psaty BM, Bild DE, Borhani NO, Newman A, Tabatznik B, Rautaharju PM: Major electrocardiographic abnormalities in persons aged 65 years and older (the Cardiovascular Health Study). Cardiovascular Health Study Collaborative Research Group. Am J Cardiol. 1992, 69: 1329-1335.CrossRefPubMed
21.
go back to reference Pan WH, Cedres LB, Liu K, Dyer A, Schoenberger JA, Shekelle RB, Stamler R, Smith D, Collette P, Stamler J: Relationship of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease mortality in men and women. Am J Epidemiol. 1986, 123: 504-516.PubMed Pan WH, Cedres LB, Liu K, Dyer A, Schoenberger JA, Shekelle RB, Stamler R, Smith D, Collette P, Stamler J: Relationship of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease mortality in men and women. Am J Epidemiol. 1986, 123: 504-516.PubMed
22.
go back to reference Hu FB, Stampfer MJ, Haffner SM, Solomon CG, Willett WC, Manson JE: Elevated risk of cardiovascular disease prior to clinical diagnosis of type 2 diabetes. Diabetes Care. 2002, 25: 1129-1134.CrossRefPubMed Hu FB, Stampfer MJ, Haffner SM, Solomon CG, Willett WC, Manson JE: Elevated risk of cardiovascular disease prior to clinical diagnosis of type 2 diabetes. Diabetes Care. 2002, 25: 1129-1134.CrossRefPubMed
23.
go back to reference Haffner SM: The importance of hyperglycemia in the nonfasting state to the development of cardiovascular disease. Endocr Rev. 1998, 19: 583-592. 10.1210/er.19.5.583.CrossRefPubMed Haffner SM: The importance of hyperglycemia in the nonfasting state to the development of cardiovascular disease. Endocr Rev. 1998, 19: 583-592. 10.1210/er.19.5.583.CrossRefPubMed
24.
go back to reference Hanefeld M: Postprandial hyperglycaemia: noxious effects on the vessel wall. Int J Clin Pract Suppl. 2002, 129: 45-50.PubMed Hanefeld M: Postprandial hyperglycaemia: noxious effects on the vessel wall. Int J Clin Pract Suppl. 2002, 129: 45-50.PubMed
25.
go back to reference Eliasson M, Asplund K, Evrin P-E, Lindahl B, Lundblad D: Hyperinsulinemia predicts low tissue plasminogen activator activity in a healthy population: The Northern Sweden Monica Study. Metabolism. 1994, 43: 1579-1586.CrossRefPubMed Eliasson M, Asplund K, Evrin P-E, Lindahl B, Lundblad D: Hyperinsulinemia predicts low tissue plasminogen activator activity in a healthy population: The Northern Sweden Monica Study. Metabolism. 1994, 43: 1579-1586.CrossRefPubMed
26.
go back to reference Soderberg S, Ahren B, Jansson JH, Johnson O, Hallmans G, Asplund K, Olsson T: Leptin is associated with increased risk of myocardial infarction. J Intern Med. 1999, 246: 409-418. 10.1046/j.1365-2796.1999.00571.x.CrossRefPubMed Soderberg S, Ahren B, Jansson JH, Johnson O, Hallmans G, Asplund K, Olsson T: Leptin is associated with increased risk of myocardial infarction. J Intern Med. 1999, 246: 409-418. 10.1046/j.1365-2796.1999.00571.x.CrossRefPubMed
27.
go back to reference Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish Diabetes Prevention Study Group: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001, 344: 1343-1350. 10.1056/NEJM200105033441801.CrossRefPubMed Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish Diabetes Prevention Study Group: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001, 344: 1343-1350. 10.1056/NEJM200105033441801.CrossRefPubMed
Metadata
Title
Silent myocardial infarction in women with impaired glucose tolerance: The Northern Sweden MONICA study
Authors
Dan Lundblad
Mats Eliasson
Publication date
01-12-2003
Publisher
BioMed Central
Published in
Cardiovascular Diabetology / Issue 1/2003
Electronic ISSN: 1475-2840
DOI
https://doi.org/10.1186/1475-2840-2-9

Other articles of this Issue 1/2003

Cardiovascular Diabetology 1/2003 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.