Insulin –like growth factor i: a predictor of lasting glucose abnormalities in patients with acute coronary syndromes

Abstract EN

BACKGROUND : In recent years attention has been devoted to the increased risk of subsequent cardiovascular mortality and morbidity in patients with acute coronary syndromes {ACSs}, and disturbed glucose metabolism, a condition that is common in such patients.

Such observation makes it of great importance to find novel and easily used markers of early stages of glucose abnormalities that may be helpful in future attempts to prevent cardiovascular events and mortality in ACSs patients .Low levels of IGF-I are associated with increased risk of cardiovascular diseases and type 2 diabetes.

OBJECTIVE : Is to test the hypothesis that concentrations of IGF-I obtained early in the course of acute coronary syndromes will identify lasting glucometabolic abnormalities.

STUDY DESIGN : 40 patients selected from the Coronary Care Unit of Cardiology department Ain Shams University hospital as acute coronary syndromes group classified into13 patients with unstable angina with mean age (55.92 ± 11.93) years and 27 patients with acute myocardial infarction with mean age (53.44 ± 10.90) years and all not known to be diabetic.

20 non-diabetic, non-cardiac subjects matching same age and sex.

as control group All were submitted to full history taking and thorough clinical examination.Laboratory investigations including fasting and random blood glucose.

On the day of hospital discharge oral glucose tolerance test (OGTT) was performed where patients were classified as having normal glucose tolerance{NGT} ,impaired glucose tolerance{IGT}or type2diabetes.

Cardiac enzymes, ECG, echocardiography and serum level of insulin like growth factor (IGF-I) were performed.

RESULTS : the serum IGF-I levels was significantly lower in ACSs group, the unstable angina group (281.92± 147.30ng / ml) and the acute myocardial infarction group (242.04±124.96ng / ml)than that detected in the control group (406.00 ± 93.40ng / ml) with (P value < 0.001) being lowest in acute myocardial infarction group.

Patients with AGT (190.00 ± 35.75ng / ml) had lower levels of IGF-I compared with those with NGT (406.67 ± 142.55ng / ml) where (P value = 0.003) and compared with control subjects with AGT (408.09 ± 9.57ng / ml) where (P value < 0.001).

However, patients with NGT (406.67±142.55ng / ml) and control subjects with NGT (418.13 ± 101.22ng / ml) didn’t differ in IGF-I.

Moreover, when dividing patients with AGT into those with IGT (191.00 ± 45.87ng / ml) and those with type 2diabetes (187.50 ± 56.56ng / ml) and comparing these groups with patients with NGT (406.67 ± 142.55ng / ml) there was a highly significant difference between the three groups, being lowest in the group with type 2 diabetes where (P value = 0.001).

CONCLUSION : IGF-I may be a clinically useful tool for the glucometabolic classification of patients with ACSs, allowing early institution of therapeutic modalities directed towards the metabolic disturbance.

It deserves further evaluation as regard its prognostic implications.