Skip to main content
SpringerLink
Log in

The use of glycosylated hemoglobin (HbA1c) as a predictor of the severity of acute coronary syndrome among diabetic patients

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

A Correction to this article was published on 05 April 2022

This article has been updated

Abstract

Background

Acute myocardial infarction in patients with type two diabetes mellitus is usually present with multiple vessel lesions during coronary angiography. The underlying mechanism remains unexplored, and there is a deficiency of serum predictive markers. Glycosylated hemoglobin (HbA1c), which is a critical measure of glycemic control, could be used as a reliable predictor of the severity of ACS.

Materials and methods

This is a prospective descriptive comparative hospital-based study measured the correlation between levels of HbA1c and the severity of ACS using the modified Gensini score (MGS). A total of 85 patients were enrolled in this study in the period between September and November 2019. The MGS depends on the number of vessels which are stenosed with the degree of stenosis more than 50% of their lumen. Data was analyzed using SPSS V. 2018. Chi-square test was used.

Results

The total number of enrolled patients was 85. Dyslipidemia was found among 63 (74.1%) patients, and 52 (69.4%) of the patients were noted to have hypertension. A total of 19 (22.4%) patients were smokers. About 59 (69.4%) patients had a family history of IHD, and 22 patients (25.9%) had a history of IHD. STEMI was the main ECG finding 54 (63.5%). Modified Gensini score depicted that 32 (35.29%) had mild acute coronary syndrome, 23(27.06%) had moderate, and 30 (37.65%) had severe acute coronary syndrome. HbA1c was significantly positively correlated with the severity of ACS among diabetic patients (P value = 0.000).

Conclusion

In diabetic patients with acute coronary syndrome, HbA1c levels can be used as a predictor for the severity of CAD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The data used in this report is available to readers.

Change history

Abbreviations

ACS:

Acute coronary syndrome

IHD:

Ischemic heart disease

DM:

Diabetes mellitus

HbA1c:

Hemoglobin A1c

MGS:

Modified Gensini score

STEMI:

ST segment elevation myocardial infarction

NSTEACS:

Non-ST-elevation acute coronary syndrome

LBBB:

Left bundle branch block

LAD:

Left axis deviation

References

  1. Butler WJ, Ostrander LD Jr, Carman WJ, Lamphiear DE (1985) Mortality from coronary heart disease in the Tecumseh study: long-term effect of diabetes mellitus, glucose tolerance and other risk factors. Am J Epidemiol 121(4):541–547

    Article  CAS  Google Scholar 

  2. Klein R (1995) Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care 18(2):258–268

    Article  CAS  Google Scholar 

  3. Nasir K, Santos RD, Tufail K et al (2007) High normal fasting blood glucose in non-diabetic range is associated with increased coronary arery calcium burden in asymptomatic men. Atherosclerosis 195(2):e155–e160

    Article  CAS  Google Scholar 

  4. Khaw KT, Wareham N, Luben R et al (2001) Glycated hemoglobin, diabetes and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk). BMJ 322(7277):15–18

    Article  CAS  Google Scholar 

  5. Nutrition recommendations and interventions for diabetes. American Diabetes Association. Diabetes Care. 2008;31:61–78

  6. Lee HJ, Her SH, Im YS et al (2009) Significance of inflammatory markers in diabetic patients with stable coronary artery disease. Korean J Intern Med 24(3):212–219

    Article  CAS  Google Scholar 

  7. Selvin E, Crainiceanu CM, Brancati FL, Coresh J (2007) Short-term variability in measures of glycemia and implications for the classification of diabetes. Arch Intern Med 167(14):1545–1551

    Article  CAS  Google Scholar 

  8. Rohlfing C, Wiedmeyer HM, Little R et al (2002) Biological variation of glycohemoglobin. ClinChem 48:1116–1118

    CAS  Google Scholar 

  9. The International Expert Committee (2009) International expert committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 32:1327–1334

    Article  Google Scholar 

  10. American Diabetes Association (2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 33(Suppl 1):S62–S69

    Article  Google Scholar 

  11. Selvin E, Steffes MW, Zhu H et al (2010) Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med 362:800–811

    Article  CAS  Google Scholar 

  12. Selvin E, Coresh J, Shahar E et al (2005) Glycemia (haemoglobin A1c) and incident of ischemic stroke: the atherosclerosis risk in communities (ARIC) study. Lancet Neurol 4(12):821–826

    Article  CAS  Google Scholar 

  13. Ravipati G, Aronow WS, Ahn C et al (2006) Association of hemoglobin A1c level with the severity of coronary artery disease in patients with diabetes mellitus. Am J Cardiol 97(7):968–969

    Article  CAS  Google Scholar 

  14. Selvin E, Wattanakit K, Steffens MW et al (2006) HbA1c and peripheral arterial disease in diabetes: the atherosclerosis risk in communities study. Diabetes Care 29(4):877–882

    Article  Google Scholar 

  15. Engoren M, Habib RH, Zacharias A et al (2008) The prevalence of elevated hemoglobin A1c in patients undergoing coronary artery bypass surgery. J CardiothoracSurg 3:63

    Google Scholar 

  16. Ahmed MH, Awadalla H, Elmadhoun WM et al (2017) Prevalence and risk factors for acute coronary syndrome among Sudanese individuals with diabetes: a population-based study. Cardiol Res 8(5):184–189. https://doi.org/10.14740/cr616w

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dong X, Cai R, Sun J et al (2017) Diabetes as a risk factor for acute coronary syndrome in women compared with men: a meta-analysis, including 10 856 279 individuals and 106 703 acute coronary syndrome events. Diabetes Metab Res Rev 33(5). https://doi.org/10.1002/dmrr.2887

  18. Hertz JT, Reardon JM, Rodrigues CG et al (2014) Acute myocardial infarction in sub-Saharan Africa: the need for data. PLoS One 9(5):e96688. https://doi.org/10.1371/journal.pone.0096688 e Collection 2014

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Awadalla H, Noor S, Elmadhoun W, et al. (2017). Diabetes complications in Sudanese individuals with type 2 diabetes: overlooked problems in sub-Saharan Africa?. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 11. https://doi.org/10.1016/j.dsx.2017.07.039

  20. Almobarak AO, Awadalla H, Osman M, Ahmed MH (2017) Prevalence of diabetic foot ulceration and associated risk factors: an old and still major public health problem in Khartoum, Sudan? Ann Transl Med 5(17):340. https://doi.org/10.21037/atm.2017.07.01

    Article  PubMed  PubMed Central  Google Scholar 

  21. Tabl M, Tabl M, Abdelmoniem A et al (2016) The Relation between Glycated Hemoglobin and Severity of Coronary Artery Disease in Non-Diabetic Patients with acute coronary syndrome. International Journal of Advanced Research 4. https://doi.org/10.21474/IJAR01/2663

  22. Leon BM, Maddox TM (2015) Diabetes and cardiovascular disease: epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes 6(13):1246–1258. https://doi.org/10.4239/wjd.v6.i13.1246

    Article  PubMed  PubMed Central  Google Scholar 

  23. Deshpande JD, Dixit JV (2008) Risk factors for acute myocardial infarction: a hospital-based case control study. Health and population: perspectives and issues 31:164–169

    Google Scholar 

  24. Yadav P, Joseph D, Joshi P (2010) Clinical profile & risk factors in acute coronary syndrome. National Journal of Community Medicine 1(2) ISSN: 0976-3325

  25. Ul Amin R, Ahmedani MAM, Karim M, Raheem A (2019) Correlation between Gensini score and duration of diabetes in patients undergoing coronary angiography. Cureus 11(2):e4010. Published 2019 Feb 4. https://doi.org/10.7759/cureus.4010

    Article  PubMed  PubMed Central  Google Scholar 

  26. Stamler J, Vaccaro O, Neaton JD, Wentworth D (1993) Diabetes, other risk factors, and 12-y cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care 16:434–444

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Teaching assistant, Faculty of Medicine, University of Gezira, Wad medani, Gezira state, Sudan

    Ahmed Abdalazim Dafallah Albashir

  2. Faculty of Medicine, University of Gezira, Wad Medani, Gezira state, Sudan

    Omer Ali Mohamed Ahmed Elawad

  3. Faculty of Medicine, University of Gezira, Wad Medani, Gezira state, Sudan

    Hussam Khougali Mohamed

Authors
  1. Ahmed Abdalazim Dafallah Albashir
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Omer Ali Mohamed Ahmed Elawad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hussam Khougali Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A A: designed the questionnaire, participated in data collection and the main writer of the article

O E: participated in data collection and writing and editing the article

H K: participated in data collection and writing and editing the article

All authors have read and approved the manuscript.

Corresponding author

Correspondence to Ahmed Abdalazim Dafallah Albashir.

Ethics declarations

Competing interests

The authors declare that they have no competing interest.

Ethical consideration

The ethical consideration was obtained from the administrative authority of the study area (hospital). Study data/information was used for research purposes only. Participation is voluntary.

Ethics approval and consent to participate

The article is accepted by the Research Ethics Committee, University of Gezira, Faculty of medicine in Sudan .

Informed consent

The informed consent was verbal

Consent for publication

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: Author wish to update his name from “Hussam S. Khougali” to “Hussam Khougali Mohamed” to match the name cited in his Institution.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Albashir, A.A.D., Elawad, O.A.M.A. & Khougali Mohamed, H. The use of glycosylated hemoglobin (HbA1c) as a predictor of the severity of acute coronary syndrome among diabetic patients. Ir J Med Sci 190, 609–614 (2021). https://doi.org/10.1007/s11845-020-02341-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-020-02341-0

Keywords

Search

Navigation