Thursday, February 28, 2008

Acute Coronary Syndrome Linked to High Blood Sugar – American Heart Association Calls for National Studies


Dr Prakash Deedwania

The American Heart Association has issued a strong statement calling for studies from the National Institute of Health and other national bodies to systematically study the relationship between elevated blood sugar and acute coronary syndrome. The statement is published online, February 25, 2008 in Circulation.

Lead study author, Dr Prakash Deedwania (University of California, San Francisco), says “There is plenty of evidence that hyperglycemia is a frequent problem in patients with ACS arriving at the hospital — as many as 25% to 50% are affected — but elevated blood sugar is frequently ignored despite being strongly associated with increased mortality." He believes we are ignoring “this prognostic indicator”. We are treating the problem of elevated blood sugar without even knowing the outcomes.

Dr. Deedwania points out that we still haven’t defined a good target for managing blood glucose levels in the setting of acute coronary syndrome. He takes it further by saying that we’ve spent “millions of dollars” studying the problem, and more money on establishing hospital protocols even though our knowledge regarding the problem is limited.

The current guidelines state that blood sugar levels should be kept between 80 and 140mg/dl. In the hospital, blood sugar levels are controlled in the ICU using intravenous Insulin. Dr. Deedwania states that “while we recognize that this is currently the most effective way of controlling glucose in this setting, we don't know whether insulin is the right way to do it." He references the recent ACCORD trial but says that study only shows that hypoglycemia was potentially harmful in the patient population involved in the ACCORD trials. He is not convinced that we should not be treating hyperglycemia.

It is suggested that hospitals vigorously screen patients with Acute Coronary Syndrome for high blood sugar. Follow up testing should be performed regarding new onset diabetes. Dr. Deedwania says we need to know “whether elevated blood glucose is a marker or a mediator of more severe myocardial damage."

The challenge here is one of action - the initiation of properly performed studies. The authors of this statement have stressed that there is value in treating hyperglycemia in the presence of acute coronary syndrome, but past studies have fallen short of the mark regarding initial evaluation, screening for new onset diabetes before hospital discharge and proper follow up after acute treatment for hyperglycemia in the ICU.

As a Nurse, I also can't say enough about advocating for yourself - this is your personal challenge. It's important to be fully informed about your own health status. Ask questions. If you or a loved one suffers a heart attack, write down questions for your doctor. Find out what treatments have been provided in the hospital and never be afraid to ask for follow up testing. Ask questions about ongoing care and stay informed of current health studies. You can never have too much information when it comes to your own well being.

Ref: http://www.theheart.org/article/845207.do
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2 comments:

  1. My wife has type 2 diabitis . This is an eye opening article . I wasn’t aware that stroke and heart attach was a side affect of diabits. She monitors her sugar several times a day, in the morning and evening. Her sugar can start off normal in the morning and evening range around 250. Even after her meds and watches careful on what she eats. My wife sees he doctor several time a year to have her blood tested. Is there more she can do on her own?

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  2. Hi,
    Thanks for your comment.
    Your wife should try very hard to keep her blood sugars in a more normal range. It's important for her to let the doctor know that her readings are in the 200 range so her medication can be adjusted. Aside from diet, exercise is important. Weight loss is also very beneficial and should be a focus. For now, though it sounds like she really need to speak with her doctor and provide her daily blood sugar readings.

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