ABSTRACT
INTRODUCTION: Quick release bromocriptine (BROM-QR), currently approved for glycemic control, reduces the risk of cardiovascular events in adults with type-2 diabetes mellitus (T2DM). This study evaluates the effect of BROM-QR on homocysteine (HOMC) and high sensitive C-reactive protein (hs-CRP), the biochemical markers of coronary atherosclerosis/inflammation, in patients with uncontrolled T2DM. METHODS: In this non-randomized, before-and-after clinical trial, patients with uncontrolled T2DM on stable doses of two oral hypoglycemic agents received BROM-QR for 6 months. The change in serum concentrations of HOMC was the primary endpoint. Anthropometric measurements such as body mass index (BMI) and waist circumference were measured at the baseline and at the completion of treatment along with fasting plasma glucose (FPG), HbA1c, total cholesterol, triglyceride, creatinine and hs-CRP. Multivariate regression analysis was performed to identify factors associated with changes in the levels of HOMC. RESULTS: In 64 patients (46 completed 6 months of treatment), age was 55±7 years and the duration of T2DM was 8.0 ± 4.4 years. On enrollment, mean HbA1c, FPG, hs-CRP and HOMC levels were 9.0± 1.3 percent, 184 ± 42 mg/dL, 3.8± 3.4 mg/dl and 10.8 ± 6.2 micromole/L; respectively. Mean decrease of 0.7 ± 1.1 percent for HbA1c (P = 0.001) and 22 ± 44 mg/dL for FPG was observed (P = 0.002). HOMC levels decreased to 8.5 ± 5.2 micromole/L (P = 0.011) while hs-CRP levels remained unchanged at 3.7 ± 2.9 mg/dL (P = 0.835). CONCLUSION: While HOMC and HbA1c levels decreased significantly after 6 months of treatment with BROM-QR in patients with T2DM, serum levels of hs-CRP, total cholesterol and triglyceride did not significantly change.
ABSTRACT
BACKGROUND: The severity of coronary artery disease (CAD) is directly related to the quality of glucose control in diabetic patients. Additionally, mortality after an acute coronary syndrome is higher in patients with diabetes and it correlates to the level of glucose control. However, the role of higher gluconated hemoglobin in the process of coronary atherosclerosis and clinical outcome of acute myocardial infarction is unknown. OBJECTIVES: To evaluate the association of HbA1c level and severity of CAD and short-term outcomes of acute ST-elevation myocardial infarction (STEMI) in nondiabetics. METHODS: A total of 290 nondiabetic patients with STEMI were prospectively enrolled following their admission. Patients were stratified into 2 groups based on the median percent of HbA1c (⩽5.8% 'Low' and >5.8% 'High'). The severity of CAD based on the Califf scoring system, in-hospital mortality and morbidities of STEMI were compared between groups. Patients were followed for 1 year after discharge to assess readmission and mortality rate. RESULTS: The severity score for CAD was significantly higher in the 'High' versus 'Low' HbA1c group (7.7 ± 2.7 and 5.5 ± 2.6, p = 0.001). A total of 15 patients died in both groups during the follow-up period. While in-hospital mortality was similar between the two groups, 12-month mortality was significantly higher in the 'High' group (7.7% versus 2.7%, p = 0.043). In addition, the rehospitalization rate within 1 year was 8.8% in the 'Low' group, which was significantly lower than 19.0% in the 'High' group (p = 0.016). CONCLUSION: Among nondiabetic patients presenting with STEMI, the severity of CAD was higher in those with HbA1c level >5.8%; 1-year mortality and hospital readmission rates were also higher in this group of patients.
