IJCEP 2019; 6(3): 86-90 www.ijcep.org International Journal of Clinical and Experimental Physiology, Vol 6, Issue 3, Jul-Sep, 2019 86 Original Article Sakkarabani Priyanka 1 , Nivedita Nanda 1, *, Gopal Krushna Pal 2 , Mukta Wy- awahare 3 , Arvind Naga- rathinam 4 1 Department of Biochemistry, Jawaha- rlal Institute of Postgraduate Medical Education and Research, Gorimedu, Dhanvantari Nagar, Puducherry, INDIA. 2 Department of Physiology, Jawaha- rlal Institute of Postgraduate Medical Education and Research, Gorimedu, Dhanvantari Nagar, Puducherry, INDIA. 3 Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Dhanvantari Nagar, Puducherry, INDIA. 4 MBBS Student, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Dhanvantari Nagar, Puducherry, INDIA. Correspondence Dr. Nivedita Nanda Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Educa- tion and Research, Gorimedu, Dhanvan- tari Nagar, Puducherry-605 006, INDIA. Email: drnnivedita@gmail.com History • Submission Date: 10-07-2019; • Review completed: 05-09-2019; • Accepted Date: 21-09-2019. DOI : 10.5530/ijcep.2019.6.3.24 Copyright © 2019 Phcog.Net. This is an open- access article distributed under the terms of the Creative Commons Attribution 4.0 International license. Cite this article: Priyanka S, Nanda N, Pal GK, Wyawahare M, Arvind N. Myocardial Work Stress is Linked to the Levels of Glycated Hemoglobin in Indian Prediabetic Population. Int J Clin Exp Physiol. 2019;6(3):86-90. ABSTRACT Background and Aim: Cardiovascular disease and diabetes mellitus are major health con- cerns In India. Prediabetes shares common pathology with these two diseases. However, the factors contributing to myocardial dysfunction in prediabetes have not been assessed. In this study, we have assessed various cardiometabolic factors contributing to myocardial work stress in in prediabetic subjects. Methods: In the present study, the anthropomet- ric parameters, parameters of insulin resistance, infammation, oxidative stress, glycated hemoglobin (HbA1c), lipid profle, atherogenic lipid risk factors and Rate-pressure Product (RPP), the marker of myocardial work stress were assessed in early middle-aged predia- betes population (n=33) and compared with healthy non-diabetic controls (n=36). Results: Prediabetes subjects had increased body mass index (P<0.01), waist-hip ratio (P<0.05), lipid risk factors of atherosclerosis [TC/ HDL-C; P<0.05, LDL C/ HDL-C; P<0.05 and atherogenic index (AI) P<0.05], HbA1c (P<0.001), oxidative stress (increased malondialdehyde; P<0.001 and decreased total antioxidant status, P<0.001) and increased high-sensitive C-reactive protein (P<0.01). They had higher Basal Heart Rate (BHR) (P<0.05) and RPP (P<0.05) de- noting increased CV risk in comparison to controls. Conclusion: There is myocardial work stress in the form of increased RPP in Indian prediabetic population. The RPP in prediabetes could be linked to increases HbA1c. RPP being a non-invasive risk marker may be studied further to assess its implication as a screening tool for determining CV risks in prediabetes. Key words: Atherogenic index, Cardiovascular risk, Myocardial work stress, Oxidative stress, Rate pressure product. Sakkarabani Priyanka 1 , Nivedita Nanda 1, *, Gopal Krushna Pal 2 , Mukta Wyawahare 3 , Arvind Nagarathinam 4 Myocardial Work Stress is Linked to the Levels of Glycated Hemoglobin in Indian Prediabetic Population INTRODUCTION Prediabetes is defned as a stage preceding diabetes mellitus characterized by impaired fasting glucose or impaired glucose tolerance or both. Fasting glu- cose and insulin assessment are preferred over time- consuming OGTT especially in young people with insulin resistance for evaluation of glycemic status. [1] Accordingly, as per the American Diabetes As- sociation (ADA) criteria, prediabetes is defned as a condition where the Fasting Serum Glucose (FSG) falls within 100-125 mg/dL (5.6 Mm/L- 6.9 mM/L). It has been reported that prediabetes is not only the high risk for future development of diabetes mel- litus [2] but also is a potential risk for Cardiovascu- lar Disease (CVD). [3] Coronary atherosclerosis and plaque vulnerability have been reported to be more advanced in prediabetes subjects compared to the non-diabetic patients. [4] CVD and Diabetes Mellitus (DM) [5,6] are two major health problems In India. Several factors such as insulin resistance, hyperglycemia, dyslipidemia, hy- pertension, infammation, etc. have been cited as the mechanisms linking prediabetes and diabetes with CVD. [7] Terefore, considering the morbidity and economic burden of CVD and DM and the underly- ing common pathophysiological mechanisms shared with prediabetes, presently the emphasis is on early identifcation of these Cardiovascular (CV) risk fac- tors in prediabetes population as part of preventive and intervention measures in India. Elevated glycated hemoglobin (HbA1c), a marker of chronic hyperglycemia, is independently associated with Cardiovascular (CV) outcomes in diabetes and even in individuals without a diabetes diagnosis. [8,9] One plausible mechanism by which hyperglycemia may contribute to CVD risk is via the development of hypertension as previous research demonstrates the associations of hyperglycemia with endothelial dysfunction and vascular stifness, both of which are linked to increased blood pressure and CVD risk. [10,11] Rate-pressure Product (RPP), the non-invasive marker of myocardial work stress, has been reported to be the indicator of the severity of type 2 diabetes, especially in diabetic neuropathy patients. [12] How- ever, to best of our knowledge, the link of HbA1c to RPP has not been reported in Indian population. Also, no study has been performed till date to assess the association of HbA1c with RPP and other mark-