The clinical burden of type 2 diabetes in patients with acute coronary syndromes: Prognosis and implications for short- and long-term management

Abstract

Type 2 diabetes mellitus (T2DM) is associated with increased morbidity and mortality in patients with acute coronary syndromes (ACS). Cardiometabolic risk factors, including hyperglycaemia, insulin resistance, atherogenic dyslipidaemia, increased visceral fat and inflammation, are associated with increased risk in this population and represent potential targets for treatment. In this review, management strategies for patients with T2DM post-ACS, both in the acute-care setting and in the long-term, are discussed. Although the benefits of long-term, aggressive, multifactorial risk factor modification are well established, a significant burden of recurrent events remains and the search for novel strategies continues. Several studies are assessing the potential cardiovascular (CV) benefits and safety of various classes of newer agents. Of these, AleCardio (aleglitazar), Examination of Cardiovascular Outcomes With Alogliptin versus Standard of Care in Patients With Type 2 Diabetes Mellitus and Acute Coronary Syndrome (EXAMINE; alogliptin) and Evaluation of LIXisenatide in Acute Coronary Syndrome (ELIXA; lixisenatide) specifically address patients with type 2 diabetes post-ACS. The mechanisms of action of these new therapies and aims of the CV outcome studies are briefly reviewed. The prevalence of type 2 diabetes continues to increase worldwide highlighting the need for new strategies that address the complex underlying processes that drive atherosclerosis and CV events in this high-risk patient population.

Cardiac computed tomography improves prediction of long-term cardiovascular events: a retrospective cohort study of type 2 diabetic with higher cardiovascular risk

“…CVEVs remains the rst causes of death in patients with D2M [16]. Our study suggest that a long course and the heavy burden of diabetes and complications may contribute to poor prognosis in patients with D2M, which is consistent to the results of some previous studies [17]. Thus, to prevent future cardiovascular events in patients with D2M, identifying patient subgroups with high-risk features and improving the prognosis through appropriate evidence-based treatment are crucial.…”

C-peptide as a risk factor of coronary artery disease in the general population

“…Since hyperglycaemia per se is already a known cardiovascular risk factor, 19 it is probably more useful in clinical terms to identify risk factors in individuals with normal blood glucose concentrations. A notable finding is that after 3.5 years of follow-up, there was still no evidence of a significant raise in the risk of coronary events in persons with hyperglycaemia, whereas such evidence was seen in persons with normal glucose but increased C-peptide concentrations.…”

Triglyceride glucose index for predicting cardiovascular outcomes after percutaneous coronary intervention in patients with type 2 diabetes mellitus and acute coronary syndrome

“…In the last few years, acute coronary syndrome (ACS), the most severe ischaemic heart disease, has been one of the leading causes of death worldwide [1]. Some patients with ACS remain at high risk for recurrent cardiovascular (CV) events despite the use of current guidelinerecommended therapies, including prompt coronary revascularization, dual anti-platelet therapy, and intensive lipid-lowering therapy.…”