The high prevalence of abnormal glucose metabolism in patients with CAD, and in particular among those with acute manifestations of the disease, was recently confirmed in large-scale surveys in both the United States and Europe. Within the U.S. CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) registry, among 46,410 patients with non-ST-elevation ACS, the prevalence of diabetes was 33%.89 Within the National Registry of Myocardial Infarction (NRMI), the prevalence of diabetes among patients presenting with ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) was 27% and 34%, respectively.90 In the Euro Heart Survey, glucose metabolism was addressed among 2854 patients with stable CAD and 2107 patients with unstable CAD.91 The overall prevalence of diabetes was approximately 30% in both groups. Among unstable CAD patients without known diabetes, an OGTT detected IGT in 36% and diabetes in 22% of cases. In the stable CAD group those proportions were 37% and 14%, respectively (Fig. 2-8).91
Diabetic patients, compared with nondiabetics, more frequently have characteristics and comorbidities that may negatively affect outcomes in the setting of ACS.92 However, several studies have shown that diabetes remains an independent predictor of short-term morbidity and mortality after accounting for imbalances in baseline characteristics, a notion recently reinforced by an analysis of the CRUSADE registry (Table 2-8).92 Also, in the lung run, diabetic patients presenting with non-ST-elevation ACS have significantly higher rates of mortality and morbidity, recurrent MI, stroke, and heart failure compared with nondiabetic counterparts.28 Recent data from the Euro Heart Survey suggest that in this setting the mortality rate is particularly high among diabetic women.4 Importantly, in ACS, even prediabetes (i.e., fasting glucose levels between 100 and 126 mg/dL) is associated with increased CV risk.93
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.