Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Rydèn, L.
Right arrow Articles by Malmberg, K.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Rydèn, L.
Right arrow Articles by Malmberg, K.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


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

References

  1. King H, Aubert RE, Herman WH. Global burden of Diabetes, 1995–2025. Prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–1431[Abstract]
  2. Clark CM, Perry RC. Type 2 diabetes and macro vascular disease. Epidemiology and etiology. Am Heart J. 1999;138:330–333
  3. Haffner SM, Lehto S, Rönnema T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–234[Abstract/Free Full Text]
  4. Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA. 1999;281:1291–1297[Abstract/Free Full Text]
  5. Malmberg K, Rydén L. Myocardial infarction in patients with diabetes mellitus. Eur Heart J. 1988;9:256–264
  6. Norhammar A, Malmberg K, Tornvall P, Rydén L, Stenestrand U, Wallentin Lthe RIKS-HIA group. The unfavourable prognosis in diabetic patients with acute myocardial infarction relates to under-utilisation of evidence-based treatment. Circulation. 2001;104:2962
  7. Malmberg K, Yusuf S, Gerstein HC, et al. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) registry. Circulation. 2000;102:1014–1019[Abstract/Free Full Text]
  8. Norhammar A, Tenerz , Nilsson G, Hamsten A, Efendíc S, Rydén L, Malmberg K. Abnormal glucose metabolism: unexpectedly common in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus. Lancet. 2002;359:2410–2444
  9. Capes S, Hunt D, Malmberg K, Gerstein H. Stress hyperglycemia and prognosis of myocardial infarction in non-diabetic and diabetic patients: a systematic overview. Lancet. 2000;355:773–778[CrossRef][Web of Science][Medline]
  10. Malmberg K, Norhammar A, Wedel H, Rydén L. Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation. 1999;99:2626–2632[Abstract/Free Full Text]
  11. Norhammar N, Rydén L, Malmberg K. Admission plasma glucose-independent riskfactor for long-term prognosis after myocardial infarction even in non-diabetic patients. Diabetes Care. 1999;22:1827–1831[Abstract/Free Full Text]
  12. Sodi-Pallares D, Bisteni A, Medrano G. The polarizing treatment of acute myocardial infarction. Dis Chest. 1963;43:424–432[Web of Science][Medline]
  13. Fath-Ordoubadi F, Beatt KJ. Glucose-insulin-potassium therapy for treatment of acute myocardial infarction: an overview of randomized placebo-controlled trials. Circulation. 1997;96:1152–1156[Abstract/Free Full Text]
  14. Diaz E, Romero Gon behalf of the ECLA collobarorative group. Metabolic modulation of acute myocardial infarction. The ECLA glucose-insulin-potassium Trial. Circulation. 1998;98:2227–2234[Abstract/Free Full Text]
  15. Ceremuzynski L, Budaj A, Czepiel A, et al. Low-dose glucose-insulin-potassium is ineffective in acute myocardial infarction: results of a randomized multicenter Pol-GIK trial. Cardiovasc Drug Ther. 1999;13:191–200[CrossRef][Web of Science][Medline]
  16. Van den Berge G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–1367[Abstract/Free Full Text]
  17. Youkoyama I, Momomura S-I, Ohtake T, et al. Reduced myocardial flow reserve in non-insulin-dependent diabetes mellitus. J Am Coll Card. 1997;30:1472–1477[Abstract]
  18. Vehkavaara S, Makimattila S, Schlenzka A, Vakkilainen J, Westerbacka J, Yki-Järvinen H. Insulin therapy improves endothelial function in type 2 diabetes. Arterioscler Thromb Vasc Biol. 2000;20:545–550[Abstract/Free Full Text]
  19. Dandona P, Aljada A, Mohanty P, et al. Insulin inhibits intranuclear nuclear factor kappa B and stimulates I kappa B in mononuclear cells in obese subjects: evidence for an anti-inflammatory effect? J Clin Endocrinol Metab. 2001;86:3257–3265[Abstract/Free Full Text]
  20. Melidonis A, Stefanidis A, Tournis S, et al. The role of strict metabolic control by insulin infusion on fibrinolytic profile during an acute coronary event in diabetic patients. Clin Cardiol. 2000;23:160–164[Web of Science][Medline]
  21. Diem P, Steffes MW, Egger M. Macrovascular disease in type 1 diabetes mellitus: effects of intesified insulin treatment. Diabetes. 2001;50:A152
  22. Tuomilehto J, Lindstrom J, Eriksson JG, et alFinnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–1350[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Rydèn, L.
Right arrow Articles by Malmberg, K.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Rydèn, L.
Right arrow Articles by Malmberg, K.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?