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Published on: June 11, 2012

Hyperglycaemia in acute coronary syndromes: risk-marker or therapeutic target?

R Anantharaman1, M Heatley, C F M Weston

  • 1Department of Cardiology, Swansea NHS Trust, Swansea SA2 8QA, UK.

Heart (British Cardiac Society)
|August 14, 2008
PubMed

Insights

High blood glucose in acute coronary syndrome (ACS) patients indicates a worse prognosis. This review explores hyperglycemia

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolism

Background:

  • Patients with acute coronary syndrome (ACS) frequently present with elevated blood glucose levels.
  • Hyperglycemia upon hospital admission is associated with poorer patient outcomes.
  • The clinical significance of this hyperglycemia extends beyond pre-existing diabetes mellitus.

Purpose of the Study:

  • To review the association between hyperglycemia and outcomes in ACS patients.
  • To present evidence that ACS-related hyperglycemia is not solely due to pre-existing diabetes.
  • To discuss the potential mechanisms by which elevated glucose impacts acute myocardial infarction (AMI) progression.
  • To evaluate the efficacy of intensive insulin therapy in improving outcomes for ACS patients.

Main Methods:

  • Literature review of studies investigating hyperglycemia in ACS.
  • Analysis of evidence linking hyperglycemia to prognosis in acute myocardial infarction (AMI).
  • Examination of proposed pathophysiological mechanisms of hyperglycemia in AMI.
  • Assessment of clinical trial data on intensive insulin treatment in ACS.

Main Results:

  • Hyperglycemia is a significant negative prognostic marker in ACS.
  • Evidence suggests ACS-induced hyperglycemia is a distinct entity from chronic diabetic hyperglycemia.
  • Proposed mechanisms include oxidative stress, inflammation, and endothelial dysfunction.
  • Data on intensive insulin therapy's benefit in ACS remains inconsistent.

Conclusions:

  • Hyperglycemia is a critical factor influencing outcomes in ACS and AMI.
  • Further research is needed to clarify the role and optimal management of hyperglycemia in ACS.
  • The potential benefits of intensive insulin therapy require more robust evidence.

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