Published online before print February 25, 2008, doi: 10.1161/CIRCULATIONAHA.107.188629
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2008;117:1610-1619.)
© 2008 American Heart Association, Inc.
AHA Scientific Statement |
Hyperglycemia and Acute Coronary Syndrome
A Scientific Statement From the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism
Hyperglycemia is common and associated with markedly increased mortality rates in patients hospitalized with acute coronary syndromes (ACS). Despite the fact that several studies have documented this association, hyperglycemia remains underappreciated as a risk factor, and it is frequently untreated in ACS patients. This is in large part due to limitations of prior studies, and the remaining critical gaps in our understanding of the relationship between hyperglycemia and poor outcomes. The main objective of the present statement is to summarize the current state of knowledge regarding the association between elevated glucose and patient outcomes in ACS and to outline the most important knowledge gaps in this field. These gaps include the need to specifically define hyperglycemia, develop optimal ways of measuring and tracking glucose values during ACS hospitalization, and better understand the physiological mechanisms responsible for poor outcomes associated with hyperglycemia. The most important issue, however, is whether elevated glucose is a direct mediator of adverse outcomes in ACS patients or just a marker of greater disease severity. Given the marked increase in short- and long-term mortality associated with hyperglycemia, there is an urgent need for definitive large randomized trials to determine whether treatment strategies aimed at glucose control will improve patient outcomes and to define specific glucose treatment targets. Although firm guidelines will need to await completion of these clinical trials, the present statement also provides consensus recommendations for hyperglycemia management in patients with ACS on the basis of the available data.
Key Words: AHA Scientific Statement • hyperglycemia • diabetes mellitus • acute coronary syndrome • prognosis
This article has been cited by other articles:
 |
|
 |
|
  Y. Li, Y. Li, Q. Feng, M. Arnold, and T. Peng Calpain activation contributes to hyperglycaemia-induced apoptosis in cardiomyocytes Cardiovasc Res, October 1, 2009; 84(1): 100 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Van den Berghe, M. Schetz, D. Vlasselaers, G. Hermans, A. Wilmer, R. Bouillon, and D. Mesotten Intensive Insulin Therapy in Critically Ill Patients: NICE-SUGAR or Leuven Blood Glucose Target? J. Clin. Endocrinol. Metab., September 1, 2009; 94(9): 3163 - 3170. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Ceriello Reply J. Am. Coll. Cardiol., July 21, 2009; 54(4): 374 - 374. [Full Text] [PDF]
|
|
|
|
|
|
R. Luan, S. Liu, T. Yin, W. B. Lau, Q. Wang, W. Guo, H. Wang, and L. Tao High glucose sensitizes adult cardiomyocytes to ischaemia/reperfusion injury through nitrative thioredoxin inactivation Cardiovasc Res, July 15, 2009; 83(2): 294 - 302. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Moghissi, M. T. Korytkowski, M. DiNardo, D. Einhorn, R. Hellman, I. B. Hirsch, S. E. Inzucchi, F. Ismail-Beigi, M. S. Kirkman, and G. E. Umpierrez American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control Diabetes Care, June 1, 2009; 32(6): 1119 - 1131. [Full Text] [PDF]
|
|
|
|
 |
|
 R Anantharaman, M Heatley, and C F M Weston Hyperglycaemia in acute coronary syndromes: risk-marker or therapeutic target? Heart, May 1, 2009; 95(9): 697 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Marfella, C. Di Filippo, M. Portoghese, F. Ferraraccio, M. R. Rizzo, M. Siniscalchi, E. Musacchio, M. D'Amico, F. Rossi, and G. Paolisso Tight Glycemic Control Reduces Heart Inflammation and Remodeling During Acute Myocardial Infarction in Hyperglycemic Patients J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1425 - 1436. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Dandona, A. Chaudhuri, and H. Ghanim Acute Myocardial Infarction, Hyperglycemia, and Insulin J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1437 - 1439. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kosiborod, S. E. Inzucchi, A. Goyal, H. M. Krumholz, F. A. Masoudi, L. Xiao, and J. A. Spertus Relationship Between Spontaneous and Iatrogenic Hypoglycemia and Mortality in Patients Hospitalized With Acute Myocardial Infarction JAMA, April 15, 2009; 301(15): 1556 - 1564. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kosiborod, S. E. Inzucchi, J. A. Spertus, Y. Wang, F. A. Masoudi, E. P. Havranek, and H. M. Krumholz Elevated Admission Glucose and Mortality in Elderly Patients Hospitalized With Heart Failure Circulation, April 14, 2009; 119(14): 1899 - 1907. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kosiborod, S. E. Inzucchi, H. M. Krumholz, F. A. Masoudi, A. Goyal, L. Xiao, P. G. Jones, S. Fiske, and J. A. Spertus Glucose Normalization and Outcomes in Patients With Acute Myocardial Infarction Arch Intern Med, March 9, 2009; 169(5): 438 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. R. Sinnaeve, P. G. Steg, K. A. A. Fox, F. Van de Werf, G. Montalescot, C. B. Granger, E. Knobel, F. A. Anderson, O. H. Dabbous, A. Avezum, et al. Association of Elevated Fasting Glucose With Increased Short-term and 6-Month Mortality in ST-Segment Elevation and Non-ST-Segment Elevation Acute Coronary Syndromes: The Global Registry of Acute Coronary Events Arch Intern Med, February 23, 2009; 169(4): 402 - 409. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Pepine Insulin as a cardiovascular therapeutic: improving glycemic control in patients with coronary artery disease. J. Am. Coll. Cardiol., February 3, 2009; 53(5 Suppl): S1 - S2. [Full Text] [PDF]
|
|
|
|
|
|
A. Ceriello, S. W. Zarich, and R. Testa Lowering glucose to prevent adverse cardiovascular outcomes in a critical care setting. J. Am. Coll. Cardiol., February 3, 2009; 53(5 Suppl): S9 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Cosentino, L. Rydén, P. Francia, and L. G. Mellbin CHAPTER 14 Diabetes Mellitus and Metabolic Syndrome ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Hamm, H. Möllmann, J.-P. Bassand, and F. van de Werf CHAPTER 16 Acute Coronary Syndromes ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, F. Van de Werf, J. Bax, A. Betriu, C. Blomstrom-Lundqvist, F. Crea, V. Falk, G. Filippatos, K. Fox, K. Huber, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology: Eur. Heart J., December 1, 2008; 29(23): 2909 - 2945. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Goyal, K. Nerenberg, H. C Gerstein, G. Umpierrez, and P. W. Wilson Insulin therapy in acute coronary syndromes: an appraisal of completed and ongoing randomised trials with important clinical end points Diabetes and Vascular Disease Research, November 1, 2008; 5(4): 276 - 284. [Abstract] [PDF]
|
|
|
|
 |
|
 M. C. Lansang and G. E. Umpierrez Management of Inpatient Hyperglycemia in Noncritically Ill Patients Diabetes Spectr, October 1, 2008; 21(4): 248 - 255. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Giugliano and E. Braunwald The Year in Non-ST-Segment Elevation Acute Coronary Syndrome J. Am. Coll. Cardiol., September 23, 2008; 52(13): 1095 - 1103. [Full Text] [PDF]
|
|
|
|
|
|
L. H. Opie Metabolic Management of Acute Myocardial Infarction Comes to the Fore and Extends Beyond Control of Hyperglycemia Circulation, April 29, 2008; 117(17): 2172 - 2177. [Full Text] [PDF]
|
|