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Hyperglycemia and Acute Coronary Syndromes

Hyperglycemia and Acute Coronary Syndromes. Cardiovascular disease and diabetes. ~65% of deaths are due to CV disease. Cardiovascular complications of T2DM. Coronary heart disease deaths  2- to 4-fold. Stroke risk  2- to 4-fold.

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Hyperglycemia and Acute Coronary Syndromes

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  1. Hyperglycemia andAcute Coronary Syndromes

  2. Cardiovascular disease and diabetes ~65% of deaths are due to CV disease Cardiovascular complications of T2DM Coronary heart disease deaths2- to 4-fold Stroke risk 2- to 4-fold Heart failure 2- to 5-fold Bell DSH. Diabetes Care. 2003;26:2433-41. Centers for Disease Control (CDC). www.cdc.gov. T2DM = type 2 diabetes mellitus

  3. Abnormal glucose metabolism in CAD n = 2107 inpatients with acute CAD; n = 2854 outpatients with stable CAD Known diabetes OGTT* 58 51 Totalpatients(%) Patients*(%) IGT IFG New DM *n = 1920 without known diabetes OGTT = oral glucose tolerance test; IGT = impaired glucose tolerance; IFG = impaired fasting glucose Bartnik M et al. Eur Heart J. 2004;25:1880-90.

  4. ADA criteria for IGT and T2DM 2-Hour plasma glucose during 75-g OGTT Fasting plasma glucose T2DM 200 mg/dL IGT T2DM 140 mg/dL 126 mg/dL IGT 100 mg/dL* Normal Normal American Diabetes Association (ADA). Diabetes Care. 2007;30(suppl 1)S4-41. World Health Organization (WHO). www.who.int/diabetes. *WHO: 110 mg/dL

  5. New-onset hyperglycemia linked to highest rate of in-hospital mortality N = 2030 hospital patients * * ICU patients Non-ICU patients *P < 0.01 vs normoglycemia and known diabetes Umpierrez GE et al. J Clin Endocrinol Metab. 2002;87:978-82.

  6. Admission glucose in AMI associated with mortality, independent of T2DM diagnosis N = 141,680 hospitalized with AMI 30 days 1 year 60 60 50 50 40 40 Mortality (%) 30 30 20 20 10 10 0 0 ≤110 >110- >140- >170- >240 ≤110 >110- >140- >170- >240 140 170 240 140 170 240 Admission glucose (mg/dL) Diabetes No diabetes AMI = acute myocardial infarction Kosiborod M et al. Circulation. 2005;111:3078-86.

  7. Stress hyperglycemia in AMI: Association with mortality risk in patients without known diabetes Hyperglycemia definition (mg/dL) Reference O’Sullivan 1991 >144 Lewandowicz 1979 ≥121 Soler 1981 ≥110 Oswald 1986 ≥144 Bellodi 1989 >121 Ravid 1975 >121 Sewdarsen 1989 ≥144 Pooled 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Unadjusted RR of in-hospital mortality after MI* Capes SE et al. Lancet. 2000;355:773-8. *vs patients with normoglycemia

  8. Baseline fasting plasma glucose levels predict HF hospitalization in high-risk patients ONTARGET/TRANSCEND; N = 31,546 with CVD or DM + end-organ damage Normal low Normal high IFG New DM DM 0.06 23% in HF hospitalization per 18 mg/dL glucose in patients with no known diabetes 0.05 0.04 Proportion with incident HF hospitalization 0.03 0.02 0.01 0.0 0 200 400 600 800 1000 1200 Follow-up (days) Log rank P < 0.001 Held C et al. Circulation. 2007;115;1371-5.

  9. Admission glucose and glucose change within 24 hours predict mortality risk N = 1469 with AMI (n = 1219 without DM) 9% in 30-day mortality per 11 mg/dL glucose in first 24 hr (P = 0.002)* 30-day mortality (%) 0 <125 125–<140 140–<170 ≥170 Baseline glucose (mg/dL) Glucose (24 hr vs baseline) ≥30 mg/dL decrease No change to<30 mg/dL decrease Increase *Multivariate analysis Goyal A et al. Eur Heart J. 2006;27:1289-97.

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