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Diabetes and acute coronary syndromes
Best Practice & Research Clinical Endocrinology & Metabolism, 06/19/09

Roffi M et al. – A review of diabetes and acute coronary syndromes (ACS) summarizes prevalence, outcomes, use of anti-platelet agents and anticoagulants, management by early invasive strategy in non-ST-ACS, reperfusion therapy in STEMI, glucose-lowering therapy, and adherence to evidence-based therapy.

• Review of diabetes and ACS

• Pts with ACS at high risk for subsequent cardiovascular events but derive greater benefit from evidence-based therapy vs non-diabetic pts
• State-of-the-art anti-thrombotic therapy: triple anti-platelet combination – aspirin, clopidogrel and glycoprotein (GP) IIb/IIIa receptor inhibitors – and unfractionated heparin or enoxaparin
• For low- or medium-risk pts, treatment based on aspirin, clopidogrel and bivalirudin is a valuable alternative
• Prasugrel: most promising anti-thrombotic agent for diabetic pts with ACS; may replace clopidogrel – and GP IIb/IIIa inhibitors
• In addition to aggressive anti-thrombotic therapy: systematic early invasive angiography for pts with with non-ST-ACS; immediate percutaneous coronary intervention for pts with STEMI
• Benefit from these strategies to more pronounced in diabetic vs non-diabetic pts
• Despite benefit, multiple surveys show in ACS setting, evidence-based therapy received less frequently by diabetic vs non-diabetic pts

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