This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nesto, R. W. Articles by Lago, R. M. Search for Related Content PubMed PubMed Citation Articles by Nesto, R. W. Articles by Lago, R. M. Related Collections Biochemistry and metabolism Type 2 diabetes Glucose intolerance Acute myocardial infarction Oxidant stress Endothelium/vascular type/nitric oxide

(Circulation. 2008;117:990-992.)
© 2008 American Heart Association, Inc.

Editorial

Glucose

A Biomarker in Acute Myocardial Infarction Ready for Prime Time?

Richard W. Nesto, MD; Rodrigo M. Lago, MD

From the Lahey Clinic, Burlington, Mass.

Correspondence to Richard W. Nesto, MD, Lahey Clinic, 41 Mall Rd, Burlington, MA 01805. E-mail richard.w.nesto@lahey.org

Key Words: Editorials • diabetes mellitus • glucose • insulin • myocardial infarction • prognosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Biomarkers are used to establish a diagnosis, provide prognostic information, and guide therapeutic interventions in patients with acute coronary syndromes. In acute myocardial infarction (AMI), white blood cell count, creatine kinase–MB isoenzymes, myoglobin, and troponin are measured for 1 or more of these purposes. Recently, brain natriuretic peptide (a measure of hemodynamic stress), interleukin-6, C-reactive protein, and soluble CD40 ligand (indices of inflammation) have been added. The plasma glucose level at the time of AMI has been a curious but distant cousin to this list. The level of glycemia correlates with short- and long-term prognosis and can also serve as a target for intervention (with insulin). In addition, the glycemic response to the stress of AMI provides important information about the metabolic status of the patient. As a result of the increasing prevalence of insulin-resistant states, hyperglycemia will be encountered more frequently in patients with AMI.^1–3 Many cardiologists may be intimidated by the implications of hyperglycemia because glucose metabolism is not part of the core curriculum of cardiology today. In this issue of Circulation, Kosiborod et al⁴ studied the interactions between levels of glycemia and cardiovascular outcomes during AMI.

Article p 1018

It is well known that, in the setting of an AMI, hyperglycemia is associated with adverse outcomes, even after adjustment for numerous "cardiac" variables linked to outcome. Previous studies have shown that an elevated plasma glucose level on admission is a major independent predictor of in-hospital and long-term outcome in patients with AMI.^5,6 Moreover, fasting glucose level . . . [Full Text of this Article]

This article has been cited by other articles:

				A. D. Pradhan, B. M. Everett, N. R. Cook, N. Rifai, and P. M Ridker Effects of Initiating Insulin and Metformin on Glycemic Control and Inflammatory Biomarkers Among Patients With Type 2 Diabetes: The LANCET Randomized Trial JAMA, September 16, 2009; 302(11): 1186 - 1194. [Abstract] [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]