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Diabetes Mellitus in Acute Coronary Syndrome

Panagiota K Stampouloglou1, Artemis Anastasiou1, Evanthia Bletsa1

  • 13rd Department of Cardiology, Thoracic Diseases General Hospital "Sotiria", National and Kapodistrian University of Athens, 11527 Athens, Greece.

Life (Basel, Switzerland)
|November 25, 2023
PubMed

Insights

Diabetes mellitus (DM) complicates acute coronary syndrome (ACS) outcomes. Non-insulin therapies show promise for managing cardiovascular risks in these patients, but more research is needed.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Diseases

Background:

  • Diabetes mellitus (DM) is a global pandemic associated with severe microvascular and macrovascular complications, including coronary artery disease (CAD).
  • Patients with acute coronary syndrome (ACS) and DM exhibit poorer prognoses due to mechanisms like insulin resistance, hyperglycemia, and endothelial dysfunction.
  • Optimal reperfusion strategies and glycemic control during myocardial infarction in diabetic patients remain challenging.

Purpose of the Study:

  • To review the pathophysiologic mechanisms linking DM and ACS.
  • To evaluate current therapeutic strategies for ACS in diabetic patients.
  • To explore the potential of novel non-insulin therapies for managing cardiovascular risk in DM.

Main Methods:

  • Review of existing literature on diabetes mellitus, acute coronary syndrome, and cardiovascular outcomes.
  • Analysis of pathophysiologic mechanisms contributing to adverse outcomes.
  • Evaluation of current and emerging treatment strategies, including surgical vs. percutaneous interventions and pharmacological therapies.

Main Results:

  • Coronary artery bypass surgery may be preferred over percutaneous coronary intervention in complex coronary anatomies for ACS patients with DM.
  • Strict glycemic control, avoiding both hyperglycemia and hypoglycemia, is crucial during the acute phase of myocardial infarction.
  • Non-insulin therapies, such as GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors, offer potential cardiovascular benefits with a lower risk of hypoglycemia.

Conclusions:

  • The optimal treatment strategy for ACS in patients with DM is still evolving.
  • Non-insulin therapies present a promising avenue for managing cardiovascular risk in diabetic patients due to their multifactorial protective effects and low hypoglycemia risk.
  • Further robust evidence from randomized controlled trials is required to confirm the benefits of newer non-insulin antidiabetic agents in this population.

Keywords:
acute coronary syndromebiomarkercoronary artery diseasediabetes mellitus

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