Hyperglycaemia in acute coronary syndromes: summary of NICE guidance

Senthinathan, A.; Kelly, Victoria; Dzingina, Mendwas; Jones, D.; Baker, Mark; Longson, Damien

doi:10.1136/bmj.d6646

Cited by 23 publications

(25 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings may also relate to the metformin group being a sicker cohort with worse diabetic phenotypes as indicated by a higher use of insulin in metformin users. In critically ill patients there is a risk of hypoglycaemia-related morbidity associated with intensive glucose control with intravenous insulin [41, 42], although we did not have data on acute glucose control in our study. In pre-clinical studies, increased myocardial rupture after AMI has been observed with metformin, which has been attributed to increased AMPK-MTOR/PGC-1α-mediated cardiomyocyte autophagy, but we were unable to assess this [43].…”

Section: Discussionmentioning

confidence: 99%

Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study

Bromage

Godec

Pujades-Rodríguez

et al. 2019

Cardiovasc Diabetol

View full text Add to dashboard Cite

BackgroundThe use of metformin after acute myocardial infarction (AMI) has been associated with reduced mortality in people with type 2 diabetes mellitus (T2DM). However, it is not known if it is acutely cardioprotective in patients taking metformin at the time of AMI. We compared patient outcomes according to metformin status at the time of admission for fatal and non-fatal AMI in a large cohort of patients in England.MethodsThis study used linked data from primary care, hospital admissions and death registry from 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of acute myocardial infarction requiring hospitalisation, stroke and cardiovascular death. The secondary endpoints were heart failure (HF) hospitalisation and all-cause mortality.Results4,030 patients with T2DM and incident AMI recorded between January 1998 and October 2010 were included. At AMI admission, 63.9% of patients were receiving metformin and 36.1% another oral hypoglycaemic drug. Median follow-up was 343 (IQR: 1–1436) days. Adjusted analyses showed an increased hazard of the composite endpoint in metformin users compared to non-users (HR 1.09 [1.01–1.19]), but not of the secondary endpoints. The higher risk of the composite endpoint in metformin users was only observed in people taking metformin at AMI admission, whereas metformin use post-AMI was associated with a reduction in risk of all-cause mortality (0.76 [0.62–0.93], P = 0.009).ConclusionsOur study suggests that metformin use at the time of first AMI is associated with increased risk of cardiovascular disease and death in patients with T2DM, while its use post-AMI might be beneficial. Further investigation in well-designed randomised controlled trials is indicated, especially in view of emerging evidence of cardioprotection from sodium-glucose co-transporter-2 (SGLT2) inhibitors.

show abstract

Section: Discussionmentioning

confidence: 99%

Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study

Bromage

Godec

Pujades-Rodríguez

et al. 2019

Cardiovasc Diabetol

View full text Add to dashboard Cite

show abstract

“…maintain a blood glucose concentration < _11.0 mmol/L or 200 mg/dL) but absolutely avoid hypoglycaemia. 282 To assess the risk of renal insufficiency, it is recommended to measure eGFR in patients on metformin and/or sodium-glucose co-transporter-2 (SGLT2) inhibitors. 6.…”

Section: Patients With Diabetesmentioning

confidence: 99%

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

Ibáñez¹,

James²,

Antunes³

et al. 2017

European Heart Journal

7,659

1,945

View full text Add to dashboard Cite

The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC (journals.permissions@oxfordjournals.org). Disclaimer. The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

show abstract

“…The substantial harm associated with hyperglycemia in patients with ACS suggests that glucose management strategies might improve outcome in patients with hyperglycemia [Angeli et al 2010[Angeli et al , 2013Senthinathan et al 2011].…”

Section: Therapeutic Implicationsmentioning

confidence: 99%

Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications

Angeli

Reboldi

Poltronieri

et al. 2015

Therapeutic Advances in Cardiovascular Disease

View full text Add to dashboard Cite

Hyperglycemia is a frequent condition in patients with acute coronary syndromes (ACS). Hyperglycemia during ACS is caused by an inflammatory and adrenergic response to ischemic stress, when catecholamines are released and glycogenolysis induced. Although the involved pathophysiological mechanisms have not yet been fully elucidated, it is believed that hyperglycemia is associated with an increase in free fat acids (which induce cardiac arrhythmias), insulin resistance, chemical inactivation of nitric oxide and the production of oxygen reactive species (with consequent microvascular and endothelial dysfunction), a prothrombotic state, and vascular inflammation. It is also related to myocardial metabolic disorders, leading to thrombosis, extension of the damaged area, reduced collateral circulation, and ischemic preconditioning. In the last few years, several observational studies demonstrated that hyperglycemia in ACS is a powerful predictor of survival, increasing the risk of immediate and long-term complications in patients both with and without previously known diabetes mellitus. Glucose management strategies in ACS may improve outcomes in patients with hyperglycemia, perhaps by reducing inflammatory and clotting mediators, by improving endothelial function and fibrinolysis and by reducing infarct size. Recent clinical trials of insulin in ACS have resulted in varying levels of benefit, but the clinical benefit of an aggressive treatment with insulin is yet unproved.

show abstract

Hyperglycaemia in acute coronary syndromes: summary of NICE guidance

Cited by 23 publications

References 4 publications

Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study

Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications

Contact Info

Product

Resources

About