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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\u003EThis article discusses the therapeutic challenges that are associated with the combination of coronary artery disease (CAD) and diabetes mellitus. The link between CAD and dysglycemia is that the release of stress hormones and peptides due to a myocardial infarction is associated with insulin resistance and increased glucose or free fatty acid levels.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EHyperglycemia is common but often undiagnosed in patients with coronary artery disease (CAD) in Europe and Asia; yet, patients with abnormal glucose tolerance have a significantly (p=0.002) higher probability of having a cardiovascular (CV) event compared with those with normal glucose tolerance [Bartnik M et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2004]. This risk can be significantly (p=0.041) reduced with glucose-lowering drugs (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Anselmino M et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2008]. In a study that assessed the relationship between impaired fasting glucose and impaired glucose tolerance, as well as diabetes mellitus (DM) and all-cause and cardiovascular disease (CVD) mortality, 65% of patients who died of CVD had known DM, newly diagnosed DM, impaired fasting glucose, or impaired glucose tolerance at baseline.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/33\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Euro Heart Survey: Improved CV Outcomes in Patients with Newly Detected Diabetes and Implementation of Diabetes Pharmacotherapy.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-774949259\u0022 data-figure-caption=\u0022Euro Heart Survey: Improved CV Outcomes in Patients with Newly Detected Diabetes and Implementation of Diabetes Pharmacotherapy.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/33\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/33\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/33\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11400\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-3\u0022 class=\u0022first-child\u0022\u003EEuro Heart Survey: Improved CV Outcomes in Patients with Newly Detected Diabetes and Implementation of Diabetes Pharmacotherapy.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAnselmino M et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2008; 29:177\u2013184. By permission of Oxford University Press.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-4\u0022\u003EProfessor Linda Mellbin, MD, Karolinska Institute, Stockholm, Sweden, discussed the therapeutic challenges that are associated with the combination of CAD and DM. She said that a possible link between CAD and dysglycemia is that the release of stress hormones and peptides due to a myocardial infarction is associated with insulin resistance and increased glucose or free fatty acid levels. They may induce oxidative stress and endothelial dysfunction, which in turn lead to inflammation, thrombus formation, and ischemia. The use of beta-blockers and glucose-lowering agents in the acute setting may limit these harmful reactions. Data have shown that intensive multifactorial therapy, in a long-term perspective, with glucose regulation and the use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents is associated with a lower risk of death from CV causes (HR, 0.43; 95% CI, 0.19 to 0.94; p=0.04) and of cardiovascular events (HR, 0.41; 95% CI, 0.25 to 0.67; p\u0026lt;0.001) [Gaede P et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EProf. Mellbin stressed the need for aggressive, guideline-based treatment to control blood pressure, lower serum cholesterol, and abolish cigarette smoking for diabetic patients with CAD.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EProfessor Lars Ryden, MD, Karolinska University Hospital, Stockholm, Sweden, listed the following 10 most important recommendations from the guidelines, jointly issued by the European Society of Cardiology and European Association for the Study of Diabetes, for adult patients with diabetes, prediabetes, and CAD (full-text document freely available at \u003Ca href=\u0022http:\/\/wwwescardio.org\u0022\u003Ehttp:\/\/wwwescardio.org\u003C\/a\u003E or \u003Ca href=\u0022http:\/\/www.easd.org\u0022\u003Ehttp:\/\/www.easd.org\u003C\/a\u003E):\u003C\/p\u003E\u003Col class=\u0022list-ord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-7\u0022\u003ETo reach all treatment targets, including glycemic control\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \u003Cp id=\u0022p-8\u0022\u003ETo screen for DM and impaired glucose tolerance by means of an OGTT in all patients with CAD and other high-risk individuals\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \u003Cp id=\u0022p-9\u0022\u003ETo see lifestyle counseling as a cornerstone in preventing DM and CVD\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \u003Cp id=\u0022p-10\u0022\u003ETo offer patients with DM and acute coronary syndrome standard, guideline-based treatment and early angiographic and mechanical revascularization\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \u003Cp id=\u0022p-11\u0022\u003ETo apply strict, when needed insulin-based, glucose control in acutely ill DM patients.\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n            \u003Cp id=\u0022p-12\u0022\u003ETo favor coronary artery bypass graft over percutaneous coronary intervention (PCI) when revascularizing DM patients\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n            \u003Cp id=\u0022p-13\u0022\u003ETo use drug-eluting stents in PCI with stent implantation\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n            \u003Cp id=\u0022p-14\u0022\u003ETo include investigations for cardiac autonomic dysfunction, heart failure, arrhythmias, hypotension, peripheral vascular disease (Doppler index), and (micro)albuminuria in routine follow-up\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n            \u003Cp id=\u0022p-15\u0022\u003ETo use a multifactorial (no smoking; tight glucose, blood pressure, and lipid control; and antiplatelet therapy) approach\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n            \u003Cp id=\u0022p-16\u0022\u003ETo establish collaboration between cardiologists and diabetologists in the management team\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ol\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 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\/9\/4\/33.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_figures.js?nzmjhp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmjhp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}