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AHA statement urges greater attention to hyperglycemia in ACS patients
26 February 2008
MedWire News: The American Heart Association (AHA) has issued a Scientific Statement calling for a national effort to address the problem of hyperglycemia in patients hospitalized with acute coronary syndromes (ACS).
\"Although studies indicate that one-fourth to one-half of ACS patents have hyperglycemia when they arrive at the hospital, elevated blood sugar is frequently ignored despite being strongly associated with increased mortality,\" explained chair of the Scientific Statements' Writing Committee Prakash Deedwania (University of California, San Francisco, USA).
The evidence for glucose management in ACS is evolving, so the statement provides guidance framed as a \"general reference\" for cardiologists, rather than the usual clear treatment protocol.
The authors have summarized current knowledge regarding the association between elevated glucose levels and patient outcomes in ACS, highlighting the most important knowledge gaps.
These gaps include a specific definition of hyperglycemia, the best way to measure and track glucose levels during hospitalization, the physiological mechanisms involved, and, most importantly, whether elevated glucose is a direct mediator of adverse outcomes in ACS patients or simply a marker of greater disease severity.
The recommendations include evaluating glucose levels in all patients with suspected or confirmed ACS and continued close monitoring of glucose levels on admission.
Physicians should consider intensive glucose control in patients with plasma glucose levels >180 mg/dl, regardless of prior diabetes history, with the goal of normalizing levels (to between 90 to 140 mg/dl) so long as hypoglycemia can be avoided.
Patients hospitalized in a non-intensive care unit setting should be treated to keep their glucose levels below 180 mg/dl.
Those patients presenting with hyperglycemia without a prior history of diabetes should be evaluated further for metabolic derangements, and plans for optimal outpatient glucose control should be set in place for patients with established or newly diagnosed diabetes or evidence of insulin resistance.
Deedwania commented: \"This is a call to action for organizations such as the National Institutes of Health (NIH) to design appropriate large, randomized clinical trials where several of these critical and clinically important questions can be answered. Only then will we be able to find and implement treatments that may reduce deaths.\"
This research ties in with the NIH's current emphasis on funding studies that could rapidly lead to improved patient care, Deedwania added.
\"We're talking about potentially saving lives and saving dollars. We need a national effort to answer these critical questions,\" he said.
Circulation 2008; Advance online publication
MedWire新闻：美国心脏病学会日前发布了一项科学性陈述旨在提高全世界医生对于住院的急性冠脉综合症患者中存在的高血糖的关注。
科学性陈述书写委员会的Prakash Deedwania（加州大学，旧金山，美国）说：“尽管有研究证实有四分之一到二分之一的因急性冠脉综合症入院的患者中存在高血糖的状态，同时高血糖与升高的病死率息息相关，但是这并没有引起临床医生们足够的重视。”
这篇陈述中同样包括了急性冠脉综合症患者血糖控制后的结果，为心血管科医生提供了一个类似“总体参照”的指导框架，而不是仅仅像平时一样给予清楚的治疗方案。
文章作者总结了目前已知的关于升高的血糖与急性冠脉综合症患者预后的知识，填补了目前关于这方面知识的空缺。
这些空缺包括了关于高血糖准确的定义，在住院病人中怎样最好的检查和检测血糖，其产生的生理机制，最重要的是，高血糖是否是导致预后不良的直接原因或者它只是提示疾病严重性的一个指标。
这篇文章建议对于所有怀疑或确诊是急性冠脉综合症的患者都应该检查血糖，并且在其住院期间应当检测血糖的浓度。
无论这名患者之前是否有糖尿病史，对于血糖高于180 mg/dl的患者，医生都应该对其进行严格的血糖控制，由于发生低血糖的风险可以被避免，应该将血糖降至90 至 140 mg/dl。
对于住在非特护病房的患者，应将血糖控制在180 mg/dl以下。
对于那些有高血糖表现但之前没有糖尿病病史的患者，应该继续复查，尽早发现可能出现的代谢异常，对于那些再随诊中心出现的糖尿病或者是胰岛素抵抗状态，应该为其指定最好的非住院病人血糖控制方案。
Deedwania说：“这篇文章也提示了一些大的机构组织，例如NIH应该指定合理的、大型的、随机的临床试验以解决其中存在的几个关键的很有临床价值的问题。只有这样，才能制定可行的治疗方法以降低死亡率。”
Deedwania补充道，这种研究也正是和目前NIH所关注的能够迅速应用于临床提高疗效的实验研究的目的相符合。
“我们是在讨论一项有可能提高治疗效果并节省金钱的方法，但是我们需要国家的支持来解决其中的关键问题。”
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发表于 2008-3-25 11:43:44