WEDNESDAY, Jan. 28 (HealthDay News) -- Cardiologists should be aware of the link between admission hyperglycemia and increased mortality in patients with acute coronary syndrome, according to an article published Feb. 3 in a supplement to the Journal of the American College of Cardiology devoted to glucose issues.
Antonio Ceriello, M.D., of the University of Warwick in Coventry, United Kingdom, and colleagues write that an association between hyperglycemia during acute coronary syndrome (ACS) and mortality has long been observed. A 2000 meta-analysis of 15 studies found a 3.9-times higher risk of death in patients with acute myocardial infarction who had blood glucose levels above 110 to 144 mg/dL. Insulin resistance is linked to many cardiovascular risk factors associated with a poorer prognosis in ACS, including obesity and endothelial dysfunction.
The authors cite American Heart Association recommendations that include the need for: glucose assessment for patients with suspected ACS in the initial laboratory evaluation; close monitoring of glucose levels in patients with ACS admitted to intensive care; considering intensive glucose control in the presence of plasma glucose above 180 mg/dL; and the use of intravenous insulin to control glucose in intensive care unit patients.
"Intensive glucose control in the hospital lowers the risk of mortality in critically ill patients. Clinical trials suggest that intensive glucose control lowers cardiovascular risk and clearly lowers the risk of renal disease. Standardized protocols are necessary that effectively achieve and maintain glucose levels within a given range and with minimal risk of hypoglycemia," the authors conclude.
A co-author disclosed financial relationships with sanofi-aventis.
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