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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003E\u201cLet\u0027s get one thing clear,\u201d said Mark Creager, MD, Harvard Medical School. \u201cDiabetes is a cardiovascular disorder.\u201d\u003C\/p\u003E\n            \u003Cp id=\u0022p-2\u0022\u003EDr. Creager reviewed links between hyperglycemia and endothelial dysfunction, including the interplay of free fatty acids that increase oxidative stress. \u201cHyperglycemia activates signaling events at the endothelial level we\u0027d just as soon never got started,\u201d he said. \u201cUltimately, hyperglycemia has a direct effect on thrombosis and fibrinolysis.\u201d\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiometabolic\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary artery disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiometabolic (Diabetes)\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDiabetes Mellitus\u2014A CV Disorder\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003E\u201cLet\u0027s get one thing clear,\u201d said Mark Creager, MD, Harvard Medical School. \u201cDiabetes is a cardiovascular disorder.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EDr. Creager reviewed links between hyperglycemia and endothelial dysfunction, including the interplay of free fatty acids that increase oxidative stress. \u201cHyperglycemia activates signaling events at the endothelial level we\u0027d just as soon never got started,\u201d he said. \u201cUltimately, hyperglycemia has a direct effect on thrombosis and fibrinolysis.\u201d\u003C\/p\u003E\n         \u003Cdiv id=\u0022sec-2\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EGIK Infusion\u003C\/h3\u003E\n            \u003Cp id=\u0022p-5\u0022\u003ERaphael Diaz, MD, Estudios Clinicos Latino America (ECLA), Rosario, Argentina, looked at a new treatment option in diabetics with CV disease\u2014glucose, insulin, and potassium (GIK) infusion.\u003C\/p\u003E\n            \u003Cp id=\u0022p-6\u0022\u003E\u201cGIK infusion has been postulated to improve mortality in both diabetic and nondiabetic patients with AMI,\u201d Dr. Diaz said. But the data so far has been contradictory.\u003C\/p\u003E\n            \u003Cp id=\u0022p-7\u0022\u003EThe Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study had a striking result: diabetic patients admitted for suspected AMI who received GIK infusion had significantly reduced mortality. DIGAMI 2 was a follow-up to the first DIGAMI trial\u2014but failed to demonstrate significant benefit from GIK infusion.\u003C\/p\u003E\n            \u003Cp id=\u0022p-8\u0022\u003EDr. Diaz served as an investigator for the CREATE-ECLA Trial which examined the effect of GIK infusion on mortality in patients with STEMI. Conducted in more than 20,000 patients with STEMI, the patients were randomly assigned to receive GIK infusion for 24 hours plus usual care or to receive usual care alone.\u003C\/p\u003E\n            \u003Cp id=\u0022p-9\u0022\u003E\u201cThe results were disappointing,\u201d said Dr. Diaz. \u201cThere were no significant differences between the GIK and control groups in rates of cardiac arrest, cardiogenic shock, or reinfarction.\u201d\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-3\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EThe Chronic Stable Patient\u003C\/h3\u003E\n            \u003Cp id=\u0022p-10\u0022\u003E\u201cWhen we say stable, we\u0027re talking about asymptomatic, not free of risk factors,\u201d said David J. Schneider, MD, University of Vermont.\u003C\/p\u003E\n            \u003Cp id=\u0022p-11\u0022\u003EPlaque rupture transforms chronic stability into an acute event, \u201cand diabetic individuals are particularly at risk,\u201d Dr. Schneider said. \u201cHyperglycemia is a potent pro-inflammatory factor. And we know that diabetics or patients with metabolic syndrome are hypercoagulable. You have to throw everything you\u0027ve got at these patients to make a difference.\u201d\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-4\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EPCI in Diabetics\u003C\/h3\u003E\n            \u003Cp id=\u0022p-12\u0022\u003E\u201cHyperglycemia is an important predictor of impaired flow in PCI,\u201d according to Richard Nesto, MD, Lahey Clinic.\u003C\/p\u003E\n            \u003Cp id=\u0022p-13\u0022\u003EDiabetics presenting for PCI are more often women, obese, with lower EFs and higher CRP levels. \u201cThey leave the cath lab in as good a shape as non-diabetics,\u201d Dr. Nesto said. But these patients tend to have more restenosis, more progressive disease, and more post-PCI complications including MI, HF, and death.\u003C\/p\u003E\n            \u003Cp id=\u0022p-14\u0022\u003E\u201cIt\u0027s diabetes\u0027 status as a metabolic disorder that contributes to poor long-term outcomes after PCI,\u201d said Dr. Nesto.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-5\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ECABG in Diabetics\u003C\/h3\u003E\n            \u003Cp id=\u0022p-15\u0022\u003E\u201cDiabetics have worse post-CABG outcomes than non-diabetics,\u201d said Mark Connolly, MD, Cathedral Advanced Cardiothoracic Surgeons.\u003C\/p\u003E\n            \u003Cp id=\u0022p-16\u0022\u003EA group of factors that Dr. Connolly called \u201cthe deadly quartet\u201d\u2014diabetes, obesity, hypertension, and hyperlipidemia\u2014carry \u201cominous risk going in to surgery.\u201d Dr. Connolly noted that every 50 mg\/dL increase in blood sugar added nearly a day in the hospital (and nearly $3,000 in additional costs).\u003C\/p\u003E\n            \u003Cp id=\u0022p-17\u0022\u003E\u201cDiabetics approaching CABG demand rigorous multidisciplinary care,\u201d Dr. Connolly said. \u201cWe must focus on intensive glucose control, lipid therapy, diet, and patient education.\u201d\u003C\/p\u003E\n         \u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/1\/29.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzly71\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}