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Who are the enemies? Diabetes mellitus — a major risk factor for ischaemic myocardial injury: new directions in the management of acute coronary syndromes in the diabetic patient

L. Rydèn* and K. Malmberg

Department of Cardiology, Karolinska Hospital, Stockholm, Sweden

* Correspondence: Professor Lars Rydén, MD, Department of Cardiology, Karolinska Hospital, 171 76 Stockholm, Sweden.

Abstract

The prevalence of type 2 diabetes mellitus is rapidly increasing, and cardiovascular disease is frequent already at the time of diagnosis. The diabetic patient has a very unfavourable prognosis following acute coronary events. This article reviews the reasons for this dismal situation. Evidence-based treatment is less well utilized among diabetic patients and improvement has the potential to improve the prognosis. This can, however, not explain all the differences in morbidity and mortality between diabetic and non-diabetic patients. Metabolic factors related to the diabetic state are of critical importance. The evidence for the beneficial effects of meticulous insulin-based glycaemic control is reviewed, together with some aspects on future treatment directions. Extensive collaboration across the specialty borders of endocrinology and cardiology is a prerequisite for further success when managing the diabetic patient at risk for cardiovascular disease.

Key Words: Acute coronary syndromes • coronary artery disease • diabetes mellitus • metabolic support • risk factor • treatment


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