HbA1c in pulmonary arterial hypertension: A marker of prognostic relevance?
Background Patients with pulmonary arterial hypertension (PAH) exhibit impaired glucose metabolism and increased insulin resistance. The clinical consequences of these metabolic changes are not known. Methods We assessed HbA1c levels in 115 patients newly diagnosed with PAH (79 females and 36 males;...
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| creator | Belly, Michael J Tiede, Henning, MD Morty, Rory E., PhD Schulz, Richard, MD Voswinckel, Robert, MD Tanislav, Christian, MD Olschewski, Horst, MD Ghofrani, Hossein A., MD Seeger, Werner, MD Reichenberger, Frank, MD |
| description | Background Patients with pulmonary arterial hypertension (PAH) exhibit impaired glucose metabolism and increased insulin resistance. The clinical consequences of these metabolic changes are not known. Methods We assessed HbA1c levels in 115 patients newly diagnosed with PAH (79 females and 36 males; mean age 49.2 years; idiopathic n = 67, collagen vascular disease n = 16, congenital heart defect n = 19, pulmonary veno-occlusive disease n = 8, portopulmonary n = 5). No patients had diabetes or were receiving anti-diabetic medication or systemic steroids. After initiation of pulmonary vasoactive treatment, patients remained in long-term follow-up. Results Initially, patients were in an advanced stage of disease (mean pulmonary arterial pressure 53 ± 18 mm Hg, cardiac index 2.3 ± 0.8 liters/min/m2 ) with a 6-minute-walk distance of 337 ± 123 meters, and in NYHA Functional Class 3.0 ± 0.7. The HbA1c was 5.73 ± 0.75%. A moderate but statistically significant positive correlation was observed between HbA1c levels and BNP ( rp = 0.41, p = 0.014), but no correlation was found with hemodynamics or 6-minute-walk distance. The 5-year survival rate for the entire group was 68%. Kaplan–Meier analysis and multivariate Cox proportional hazard models correcting for demographic and clinical covariates revealed that patients with HbA1c |
| doi_str_mv | 10.1016/j.healun.2012.08.014 |
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The clinical consequences of these metabolic changes are not known. Methods We assessed HbA1c levels in 115 patients newly diagnosed with PAH (79 females and 36 males; mean age 49.2 years; idiopathic n = 67, collagen vascular disease n = 16, congenital heart defect n = 19, pulmonary veno-occlusive disease n = 8, portopulmonary n = 5). No patients had diabetes or were receiving anti-diabetic medication or systemic steroids. After initiation of pulmonary vasoactive treatment, patients remained in long-term follow-up. Results Initially, patients were in an advanced stage of disease (mean pulmonary arterial pressure 53 ± 18 mm Hg, cardiac index 2.3 ± 0.8 liters/min/m2 ) with a 6-minute-walk distance of 337 ± 123 meters, and in NYHA Functional Class 3.0 ± 0.7. The HbA1c was 5.73 ± 0.75%. A moderate but statistically significant positive correlation was observed between HbA1c levels and BNP ( rp = 0.41, p = 0.014), but no correlation was found with hemodynamics or 6-minute-walk distance. The 5-year survival rate for the entire group was 68%. Kaplan–Meier analysis and multivariate Cox proportional hazard models correcting for demographic and clinical covariates revealed that patients with HbA1c <5.7% had a significantly better 5-year survival compared with those having higher initial values (85.1% vs 55.9%; log rank p = 0.002). HbA1c was a predictor of all-cause mortality with a hazard ratio of 2.23 (95% CI 1.06 to 4.70; p = 0.034) per 1-unit increase of HbA1c. Conclusions In patients with pulmonary arterial hypertension, the HbA1c level at time of diagnosis is an independent predictor of long-term prognosis.</description><identifier>ISSN: 1053-2498</identifier><identifier>EISSN: 1557-3117</identifier><identifier>DOI: 10.1016/j.healun.2012.08.014</identifier><identifier>PMID: 22975101</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Biomarkers - blood ; Cardiology. Vascular system ; diabetes mellitus ; Familial Primary Pulmonary Hypertension ; Female ; Follow-Up Studies ; glucose metabolism disorder ; Glycated Hemoglobin A - metabolism ; glycosylated hemoglobin A1c ; Humans ; Hypertension, Pulmonary - blood ; Hypertension, Pulmonary - diagnosis ; Hypertension, Pulmonary - mortality ; impaired glucose metabolism ; insulin resistance ; Kaplan-Meier Estimate ; Longitudinal Studies ; Male ; Medical sciences ; Middle Aged ; Pneumology ; Prognosis ; Proportional Hazards Models ; pulmonary arterial hypertension ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Rate</subject><ispartof>The Journal of heart and lung transplantation, 2012-10, Vol.31 (10), p.1109-1114</ispartof><rights>International Society for Heart and Lung Transplantation</rights><rights>2012 International Society for Heart and Lung Transplantation</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3581-c1720f1875be5c57ba4de6ece481761f2f893e81b338b019e4b496d1a07f37f53</citedby><cites>FETCH-LOGICAL-c3581-c1720f1875be5c57ba4de6ece481761f2f893e81b338b019e4b496d1a07f37f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.healun.2012.08.014$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27928,27929,45999</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26389255$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22975101$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Belly, Michael J</creatorcontrib><creatorcontrib>Tiede, Henning, MD</creatorcontrib><creatorcontrib>Morty, Rory E., PhD</creatorcontrib><creatorcontrib>Schulz, Richard, MD</creatorcontrib><creatorcontrib>Voswinckel, Robert, MD</creatorcontrib><creatorcontrib>Tanislav, Christian, MD</creatorcontrib><creatorcontrib>Olschewski, Horst, MD</creatorcontrib><creatorcontrib>Ghofrani, Hossein A., MD</creatorcontrib><creatorcontrib>Seeger, Werner, MD</creatorcontrib><creatorcontrib>Reichenberger, Frank, MD</creatorcontrib><title>HbA1c in pulmonary arterial hypertension: A marker of prognostic relevance?</title><title>The Journal of heart and lung transplantation</title><addtitle>J Heart Lung Transplant</addtitle><description>Background Patients with pulmonary arterial hypertension (PAH) exhibit impaired glucose metabolism and increased insulin resistance. The clinical consequences of these metabolic changes are not known. Methods We assessed HbA1c levels in 115 patients newly diagnosed with PAH (79 females and 36 males; mean age 49.2 years; idiopathic n = 67, collagen vascular disease n = 16, congenital heart defect n = 19, pulmonary veno-occlusive disease n = 8, portopulmonary n = 5). No patients had diabetes or were receiving anti-diabetic medication or systemic steroids. After initiation of pulmonary vasoactive treatment, patients remained in long-term follow-up. Results Initially, patients were in an advanced stage of disease (mean pulmonary arterial pressure 53 ± 18 mm Hg, cardiac index 2.3 ± 0.8 liters/min/m2 ) with a 6-minute-walk distance of 337 ± 123 meters, and in NYHA Functional Class 3.0 ± 0.7. The HbA1c was 5.73 ± 0.75%. A moderate but statistically significant positive correlation was observed between HbA1c levels and BNP ( rp = 0.41, p = 0.014), but no correlation was found with hemodynamics or 6-minute-walk distance. The 5-year survival rate for the entire group was 68%. Kaplan–Meier analysis and multivariate Cox proportional hazard models correcting for demographic and clinical covariates revealed that patients with HbA1c <5.7% had a significantly better 5-year survival compared with those having higher initial values (85.1% vs 55.9%; log rank p = 0.002). HbA1c was a predictor of all-cause mortality with a hazard ratio of 2.23 (95% CI 1.06 to 4.70; p = 0.034) per 1-unit increase of HbA1c. Conclusions In patients with pulmonary arterial hypertension, the HbA1c level at time of diagnosis is an independent predictor of long-term prognosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Cardiology. Vascular system</subject><subject>diabetes mellitus</subject><subject>Familial Primary Pulmonary Hypertension</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>glucose metabolism disorder</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>glycosylated hemoglobin A1c</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - blood</subject><subject>Hypertension, Pulmonary - diagnosis</subject><subject>Hypertension, Pulmonary - mortality</subject><subject>impaired glucose metabolism</subject><subject>insulin resistance</subject><subject>Kaplan-Meier Estimate</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pneumology</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>pulmonary arterial hypertension</subject><subject>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Rate</subject><issn>1053-2498</issn><issn>1557-3117</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhi0Eoh_wDxDyBYlLgseOE4cDaFVRiqjUQ-FsOc6Eeuu1F3tTaf89jnahEpeePIdn3hk_Q8gbYDUwaD-s6zs0fg41Z8BrpmoGzTNyClJ2lQDonpeaSVHxplcn5CznNWOMC8lfkhPO-06WlFPy_WpYgaUu0O3sNzGYtKcm7TA54-ndfoulDtnF8JGu6Make0w0TnSb4q8Q885ZmtDjgwkWP78iLybjM74-vufk5-WXHxdX1fXN128Xq-vKCqmgstBxNoHq5IDSym4wzYgtWmwUdC1MfFK9QAWDEGpg0GMzNH07gmHdJLpJinPy_pBbtvg9Y97pjcsWvTcB45w1MNErJZViBW0OqE0x54ST3iZXvrEvkF406rU-aNSLRs2ULhpL29vjhHnY4Piv6a-3Arw7AiZb46dUBLj8yLVC9Vwuq346cFh8PDhMOluHRdboEtqdHqN7apP_A6x3wZWZ97jHvI5zCsW1Bp1Lj75dTr5cHJYQzoX4A8GppgA</recordid><startdate>201210</startdate><enddate>201210</enddate><creator>Belly, Michael J</creator><creator>Tiede, Henning, MD</creator><creator>Morty, Rory E., PhD</creator><creator>Schulz, Richard, MD</creator><creator>Voswinckel, Robert, MD</creator><creator>Tanislav, Christian, MD</creator><creator>Olschewski, Horst, MD</creator><creator>Ghofrani, Hossein A., MD</creator><creator>Seeger, Werner, MD</creator><creator>Reichenberger, Frank, MD</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201210</creationdate><title>HbA1c in pulmonary arterial hypertension: A marker of prognostic relevance?</title><author>Belly, Michael J ; Tiede, Henning, MD ; Morty, Rory E., PhD ; Schulz, Richard, MD ; Voswinckel, Robert, MD ; Tanislav, Christian, MD ; Olschewski, Horst, MD ; Ghofrani, Hossein A., MD ; Seeger, Werner, MD ; Reichenberger, Frank, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3581-c1720f1875be5c57ba4de6ece481761f2f893e81b338b019e4b496d1a07f37f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Cardiology. Vascular system</topic><topic>diabetes mellitus</topic><topic>Familial Primary Pulmonary Hypertension</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>glucose metabolism disorder</topic><topic>Glycated Hemoglobin A - metabolism</topic><topic>glycosylated hemoglobin A1c</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - blood</topic><topic>Hypertension, Pulmonary - diagnosis</topic><topic>Hypertension, Pulmonary - mortality</topic><topic>impaired glucose metabolism</topic><topic>insulin resistance</topic><topic>Kaplan-Meier Estimate</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pneumology</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>pulmonary arterial hypertension</topic><topic>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Belly, Michael J</creatorcontrib><creatorcontrib>Tiede, Henning, MD</creatorcontrib><creatorcontrib>Morty, Rory E., PhD</creatorcontrib><creatorcontrib>Schulz, Richard, MD</creatorcontrib><creatorcontrib>Voswinckel, Robert, MD</creatorcontrib><creatorcontrib>Tanislav, Christian, MD</creatorcontrib><creatorcontrib>Olschewski, Horst, MD</creatorcontrib><creatorcontrib>Ghofrani, Hossein A., MD</creatorcontrib><creatorcontrib>Seeger, Werner, MD</creatorcontrib><creatorcontrib>Reichenberger, Frank, MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of heart and lung transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Belly, Michael J</au><au>Tiede, Henning, MD</au><au>Morty, Rory E., PhD</au><au>Schulz, Richard, MD</au><au>Voswinckel, Robert, MD</au><au>Tanislav, Christian, MD</au><au>Olschewski, Horst, MD</au><au>Ghofrani, Hossein A., MD</au><au>Seeger, Werner, MD</au><au>Reichenberger, Frank, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>HbA1c in pulmonary arterial hypertension: A marker of prognostic relevance?</atitle><jtitle>The Journal of heart and lung transplantation</jtitle><addtitle>J Heart Lung Transplant</addtitle><date>2012-10</date><risdate>2012</risdate><volume>31</volume><issue>10</issue><spage>1109</spage><epage>1114</epage><pages>1109-1114</pages><issn>1053-2498</issn><eissn>1557-3117</eissn><abstract>Background Patients with pulmonary arterial hypertension (PAH) exhibit impaired glucose metabolism and increased insulin resistance. The clinical consequences of these metabolic changes are not known. Methods We assessed HbA1c levels in 115 patients newly diagnosed with PAH (79 females and 36 males; mean age 49.2 years; idiopathic n = 67, collagen vascular disease n = 16, congenital heart defect n = 19, pulmonary veno-occlusive disease n = 8, portopulmonary n = 5). No patients had diabetes or were receiving anti-diabetic medication or systemic steroids. After initiation of pulmonary vasoactive treatment, patients remained in long-term follow-up. Results Initially, patients were in an advanced stage of disease (mean pulmonary arterial pressure 53 ± 18 mm Hg, cardiac index 2.3 ± 0.8 liters/min/m2 ) with a 6-minute-walk distance of 337 ± 123 meters, and in NYHA Functional Class 3.0 ± 0.7. The HbA1c was 5.73 ± 0.75%. A moderate but statistically significant positive correlation was observed between HbA1c levels and BNP ( rp = 0.41, p = 0.014), but no correlation was found with hemodynamics or 6-minute-walk distance. The 5-year survival rate for the entire group was 68%. Kaplan–Meier analysis and multivariate Cox proportional hazard models correcting for demographic and clinical covariates revealed that patients with HbA1c <5.7% had a significantly better 5-year survival compared with those having higher initial values (85.1% vs 55.9%; log rank p = 0.002). HbA1c was a predictor of all-cause mortality with a hazard ratio of 2.23 (95% CI 1.06 to 4.70; p = 0.034) per 1-unit increase of HbA1c. Conclusions In patients with pulmonary arterial hypertension, the HbA1c level at time of diagnosis is an independent predictor of long-term prognosis.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22975101</pmid><doi>10.1016/j.healun.2012.08.014</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Biomarkers - blood Cardiology. Vascular system diabetes mellitus Familial Primary Pulmonary Hypertension Female Follow-Up Studies glucose metabolism disorder Glycated Hemoglobin A - metabolism glycosylated hemoglobin A1c Humans Hypertension, Pulmonary - blood Hypertension, Pulmonary - diagnosis Hypertension, Pulmonary - mortality impaired glucose metabolism insulin resistance Kaplan-Meier Estimate Longitudinal Studies Male Medical sciences Middle Aged Pneumology Prognosis Proportional Hazards Models pulmonary arterial hypertension Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Rate |
| title | HbA1c in pulmonary arterial hypertension: A marker of prognostic relevance? |
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