Impact of pre-diabetic state on clinical outcomes in patients with acute coronary syndrome

Diabetes mellitus is a well recognised risk factor for cardiovascular disease and diabetic individuals with acute coronary syndrome (ACS) have a two- to fourfold increased risk of adverse cardiovascular events compared to non-diabetic individuals.1 It is becoming increasingly clear that impaired glucose metabolism and the pre-diabetic state are also associated with adverse clinical outcomes. A retrospective study of 197 patients by Norhammar et al2 showed that among non-diabetic patients with acute myocardial infarction, those with higher admission blood glucose had higher rates of death, rehospitalisation for heart failure, and rehospitalisation for non-fatal reinfarction. In this study, admission plasma glucose was an independent predictor of non-fatal reinfarction, hospitalisation for heart failure, and a major adverse cardiovascular event (MACE).2 Another study by Norhammar et al revealed that 35% of patients admitted to the coronary care unit with a myocardial infarction and no prior diagnosis of diabetes may have an abnormal glucose tolerance test at discharge.3

The American Diabetes Association (ADA) recently redefined the cut off point for normal fasting blood glucose concentrations from 110 mg/dl to 100 mg/dl, meaning that a value of 100 mg/dl or above would lead to a diagnosis of impaired fasting glucose, which is included in the term pre-diabetes.4 The impact of the new guideline is immense. Health and human services estimate that …