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Hyperglycaemia and its therapy during acute coronary syndromes

Silvio E Inzucchi Diabetes and Vascular Disease Research 2008 5: 259 DOI: 10.3132/dvdr.2008.037 The online version of this article can be found at: http://dvr.sagepub.com/content/5/4/259.citation

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EDITORIAL

Hyperglycaemia and its therapy during acute coronary syndromes

iabetes and cardiovascular disease are intricately linked conditions. It is well established that diabetes increases the risk of a variety of macrovascular events, including myocardial infarction, stroke and heart failure. Moreover, within a general population of patients affected by cardiovascular disease, disorders of glucose metabolism, including but not solely diabetes, are extremely common. Because of these relationships and because of the increasing frequency of diabetes throughout the world, the impact of antihyperglycaemic therapy on cardiovascular outcomes in diabetic patients is of significant interest. For the cardiologist and the endocrinologist alike, an important aspect of this question is the treatment of acute hyperglycaemia during acute coronary syndromes. Stress hyperglycaemia is extremely common in the setting of acute myocardial infarction both in patients with and without a pre-existing diagnosis of diabetes. Moreover, multiple investigations have clearly demonstrated an increased risk of adverse events following myocardial infarction in those patients with the highest circulating glucose concentrations during their hospitalisations. It remains unclear, however, whether glucose is behaving as an indicator of the underlying diabetic state or predisposition or as a marker of the severity of the ventricular injury and its haemodynamic consequence, as opposed to a true mediator of unfavourable clinical outcomes. While there is as of yet no consensus regarding the importance of controlling acute hyperglycaemia in the acute coronary syndrome setting, several trials have suggested an important benefit. In light of this controversy, we have asked key opinion leaders in this area to convene this special edition of Diabetes & Vascular Disease Research. Dr Antonio Ceriello of Warwick Medical School in Coventry, UK reviews the cardiovascular effects of hyperglycaemia, highlighting the

pathophysiological processes that might link acute elevations of blood glucose during acute myocardial infarction to adverse clinical outcomes. Next, Dr Mikhail Kosiborod from the Mid-American Heart Institute in Kansas City, Missouri, US reviews the prognostic implications of hyperglycaemia in patients with acute myocardial infarction. Dr Abhinav Goyal and colleagues from Emory University, Atlanta, Georgia, US summarise the clinical trial data on use of intensive insulin therapy to address hyperglycaemia in the setting of acute coronary syndromes. Finally, Dr Lars Rydn and his group from the Karolinska Institute in Stockholm, Sweden describe the long-term implications of abnormal glucose metabolism in patients with coronary artery disease, with a focus on those with acute coronary syndromes. From this quartet of papers, it is our hope that the reader will glean a comprehensive understanding of the important association between acute hyperglycaemia and its adverse clinical sequelae in patients hospitalised for coronary artery disease, as well as an appreciation of the controversies surrounding its therapy. Conflict of interest statement None declared.
Correspondence to: Dr Silvio E Inzucchi Professor of Medicine LLCI-101 / Endocrinology, Yale University School of Medicine, 333 Cedar Street New Haven, Connecticut, 06520-8020, US. Tel: +1 203 737 1932; Fax: +1 203 737 2812 E-mail: silvio.inzucchi@yale.edu Diabetes Vasc Dis Res 2008;5:259

doi:10.3132/dvdr.2008.037

VOLUME 5 ISSUE 4 . NOVEMBER 2008

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