HbA1c as a prognostic indicator in prediabetics with acute coronary syndrome


  • Arathi S. Gadwalkar Department of General Medicine, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
  • Prabhakar K. Department of General Medicine, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
  • Raveesha A. Department of General Medicine, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
  • Shaama Ghungroo Department of General Medicine, Sri Devaraj Urs Medical College, Kolar, Karnataka, India




Acute coronary syndrome, HbA1c, MACE, Nondiabetic, Prediabetes


Background: The role of HbA1C in predicting the outcomes of acute coronary syndrome remains controversial. Lesser is known about it in non-diabetic patients. Therefore authors conducted a study to seek association between the HbA1C levels and the clinical outcome in non-diabetic patients who presented with acute coronary syndrome. Objective of the study was to estimate HbA1C levels in population of prediabetics and non-diabetics and to document and correlate major adverse cardiac events in prediabetic and non-diabetics.

Method: This case control study included consecutive patients (n=68) without known diabetes mellitus admitted with acute coronary syndrome (STEMI, NSTEMI, UA) at our hospital. HbA1c was measured on admission. The patients were divided into 2 groups according to their HbA1c level (group 1 HbA1c<5.7%, group 2 HbA1c>5.7%). The main outcome was MACE (major adverse cardiac events including cardiogenic shock, arrhythmia, heart failure).

Results: There was no significant difference between baseline characteristics of both groups but complications were seen in higher number cases with HbA1c >5.7%. No significant difference in mortality was found. On analysis HbA1c >5.7% was found to be an independent predictor of MACE.

Conclusion: HbA1C is a predictor of major adverse cardiac events. Measurement of HbA1C levels may improve risk assessment in such patients presenting with ACS.


DeFronzo RA. Insulin resistance, lipotoxicity, type2 diabetes and atherosclerosis: the missing links. The Claude Bernard Lecture 2009. Diabetol. 2010;53:1270-87.

Ostenson CG. The pathophysiology of type 2 diabetes mellitus: An overview. Acta Physiol Scand. 2001;171(3):241-7.

Karlsberg RD, Cryer PE, Roberts R. Serial plasma catecholamine response early in the course of clinical acute myocardial infarction relationship to infarct extent and mortality. Am Heart J. 1981;102:24-9

Husband DJ, Alberti KGMM, Julian DG. Stress hyperglycemia during acute myocardial infarction: An indicator of preexisting diabetes. Lancet. 1983;2:179-81.

McCowen K, Malhotra A, Bistrian B. Stress-induced hyperglycemia. Crit Care Clin. 2001;17:107-24.

Huberlant V, Preiser J. Year in review 2009: critical care – metabolism. Crit Care. 2010;14:238.

Timmer JR, Vander Horst ICC, Ottervanger JP, Henriqves JPS, Hoornlje JCA, Boer MJ, et al. Prognosticvalueofadmissionglucoseinnondiabeticpatientswith myocardial infarction. Am Heart J. 2004;148:399.

Williams SB, Goldfine AB, Timimi FK, Ting HH, Roddy MA, Simanson DC, et al. Acute hyperglycemia attenuates endothelium dependent vasodilatation in humans in vivo. Circulation. 1998; 97:1695-01.

Kersten JR, Toller WG, Gross ER, Pagel PS, Warltier DC. Diabetes abolishes ischemic preconditioning: role of glucose, insulin, and osmolality. Am J Physiol Heart Circ Physiol. 2000;278:H1218-H24.

Bauters C, Ennezat P, Tricot O, Lauwerier B, Lallemant R, Saadouni H, et al. Stress hyperglycaemia is an independent predictor of left ventricular remodelling after first anterior myocardial infarction in non-diabetic patients. Eur Heart J. 2007;28:546-52.

Oliver M, Opie L. Effects of glucose and fatty acids on myocardial ischaemia and arrhythmias. Lancet. 1994;343:155-8.

Zarich S. Mechanism by which hyperglycemia plays a role in the setting of acute cardiovascular illness. Rev Cardiovasc Med. 2006;7(Suppl. 2):S35-S43.

Ferroni P, Basili S, Falco A, Davi G. Platelet activation in type 2 diabetes mellitus. J Thromb Haemost. 2004:1282-91.

Tyagi B, Vishvanayak V, Singhal A, Singh V. The Study of Major Modifiable Risk Factor in Established Coronary Artery Disease Patients at a Tertiary Care Centre in Moradabad. Annals of Inter med Dental Res. 2017;3(3).

Nakajima T, Schulte S, Warrington KJ, Kopecky SL, Frye RL, Goronzy JJ, et al. T cell mediated lysis of endothelial cells in acute coronary syndrome. Circulation. 2002;105:570-5.

Bunn HF, Kenneth H, Gabbay, Gallop M. The glycosylation of haemoglobin: Relevance to diabetes mellitus. Sci. 1978;200:21-5.

Trivelli LA, Ranney HM, Lai HT. Haemoglobin components in patients with diabetes mellitus. N Engl J Med. 1971;284:353-7.

Fluckiger R, Mortensen HB. Review: Glycatedhaemoglobins. J Chrom. 1988;429:279-92.

American Diabetes Association. Standards of Carenin diabetes 2018. Diab Care. 2018:33.

Carr ME. Diabetes Mellitus: A hypercoagulable State. J Diab Comp. 2001;15(1):44-54.

Mani VE, John M, Calton R. Impact of HbA1c on acute cardiac states. JAPI. 2011 Jun;59(6):1-3.

Razzaq MK, Rasheed JI, Mohmmad HS. The value of admission glucose and glycosylated hemoglobin in patients with acute coronary syndrome. Iraqi Postgrad Med J. 2013:12.

Rahbar S. An abnormal hemoglobin in red cells of diabetics. Clin Chem Acta. 1968;22:296-8.

Gaziano JM, Hennekens CH, O’Donnell CJ, Breslow JL, Buring JE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation. 1997 Oct 21;96(8):2520-5.

Boizel R, Benhamou PY, Lardy B, Laporte F, Foulon T, Halimi S. Ratio of triglycerides to HDL cholesterol is an indicator of LDL particle size in patients with type 2 diabetes and normal HDL cholesterol levels. Diab Care. 2000 Nov 1;23(11):1679-85.

Miyazaki Y, Furugen M, Akasaka H, Saitoh S, Miura T. Atherogenic lipids profile relates to postprandial hyperglycemia and hyperinsulinemia due to whole body insulin resistance in prediabetic subjects. J Diab Mel. 2012;2:272-8.

Mak KH, Mah PK, Tey BH, Sin FL, Chia G. Fasting blood sugar level: a determinant for in-hospital outcome in patients with first myocardial infarction and without glucose intolerance. Annals Acad Med, Singapore. 1993 May;22(3):291-5.




How to Cite

Gadwalkar, A. S., K., P., A., R., & Ghungroo, S. (2020). HbA1c as a prognostic indicator in prediabetics with acute coronary syndrome. International Journal of Research in Medical Sciences, 8(6), 2004–2012. https://doi.org/10.18203/2320-6012.ijrms20202030



Original Research Articles