2016


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2016/№4

On the issue of carbohydrate metabolic control in acute coronary syndrome with dysglycemia

Ruyatkina L. A.1, Ruyatkin D. S.1, Ovsyannikova A. K.2
1 – State Budgetary Educational Institution of Higher Professional Education “Novosibirsk State Medical University”, RF Ministry of Health Care, Krasnyj Prospekt 52, Novosibirsk 630091
2 – Federal State Budgetary Institution, “Research Institute of Therapy and Preventive Medicine” at the Siberian Branch of Russian Academy of Medical Sciences, Borisa Bogatkova 175/1, Novosibirsk, 630089, Russia

Keywords: ACS, myocardial infarction, type 2 diabetes mellitus, dysglycemia, blood glucose lowering therapy

DOI: 10.18087/rhj.2016.4.2213

Formation of unstable atherosclerotic plaques typical of type 2 DM results in increased risk of ACS. The authors discuss the choice of hypoglycemic drugs, “old” (insulin therapy, sulfonylurea and metformin) and “new” (with incretin mechanism) ones, for reducing further cardiovascular risk based on results of randomized clinical studies. The problem is complicated by possible DM onset or development of stress-induced hyperglycemia in ACS, which together with type 2 DM form the core of dysglycemia syndrome. Diagnostic and target parameters of carbohydrate metabolism (fasting and postprandial glycaemia, glycemic variability, glycated hemoglobin) are discussed.
  1. Ferrannini E, DeFronzo RA. Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes. Eur Heart J. 2015 Sep 7;36 (34):2288–96.
  2. Эрлих А. Д., Грацианский Н. А. Острый коронарный синдром у больных сахарным диабетом. Данные регистра РЕКОРД. Кардиология. 2011;51 (11):16–21 [E`rlix A. D., Graczianskij N. A. Ostry`j koronarny`j sindrom u bol`ny`x saxarny`m diabetom. Danny`e registra REKORD. Kardiologiya. 2011;51 (11):16–21].
  3. Каретникова В. Н., Барбараш О. Л., Квиткова Л. В., Груздева О. В., Еленская Т. С., Благовещенская О. П. и др. Раннее выявление нарушений углеводного метаболизма – важный маркер отдаленного прогноза при инфаркте миокарда. Патология кровообращения и кардиохирургия. 2010;2:35–7 [Karetnikova V. N., Barbarash O. L., Kvitkova L. V., Gruzdeva O. V., Elenskaya T. S., Blagoveshhenskaya O. P. i dr. Rannee vy`yavlenie narushenij uglevodnogo metabolizma – vazhny`j marker otdalennogo prognoza pri infarkte miokarda. Patologiya krovoobrashheniya i kardioxirurgiya. 2010;2:35–7].
  4. Квиткова Л. В., Еленская Т. С., Благовещенская О. П., Зинчук С. Ф., Зинчук В. Г., Барбараш О. Л. Влияние инсулинорезистентности и нарушений углеводного обмена на течение острого периода инфаркта миокарда. Проблемы эндокринологии. 2011;57 (2):9–13 [Kvitkova L. V., Elenskaya T. S., Blagoveshhenskaya O. P., Zinchuk S. F., Zinchuk V. G., Barbarash O. L. Vliyanie insulinorezistentnosti i narushenij uglevodnogo obmena na techenie ostrogo perioda infarkta miokarda. Problemy` e`ndokrinologii. 2011;57 (2):9–13].
  5. Дедов И. И., Шестакова М. В., Галстян Г. Р., Григорян О. Р., Есаян Р. М., Калашников В. Ю. и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом: 7‑й выпуск. Сахарный диабет. 2015;18 (1S): 1–112 [Dedov I. I., Shestakova M. V., Galstyan G. R., Grigoryan O. R., Esayan R. M., Kalashnikov V. Yu. i dr. Algoritmy` speczializirovannoj mediczinskoj pomoshhi bol`ny`m saxarny`m diabetom: 7‑j vy`pusk. Saxarny`j diabet. 2015;18 (1S): 1–112].
  6. Ryden L, Grant PJ, Anker SD, Beme C, Cosentino F, Danchin N et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013 Oct;34 (39):3035–87.
  7. Стронгин Л. Г., Беляева Н. Г., Панова Е. И. Значение гликемического контроля в остром периоде инфаркта миокарда у больных сахарным диабетом 2 типа. Сахарный диабет. 2008;1:15–8 [Strongin L. G., Belyaeva N. G., Panova E. I. Znachenie glikemicheskogo kontrolya v ostrom periode infarkta miokarda u bol`ny`x saxarny`m diabetom 2 tipa. Saxarny`j diabet. 2008;1:15–8].
  8. Goyal A, Mahaffey KW, Garg J, Nicolau JC, Hochman JS, Weaver WD et al. Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the CARDINAL study. Eur Heart J. 2006 Jun;27 (11):1289–97.
  9. Кремнева Л. В., Шалаев С. В. Гипергликемия у больных острым коронарным синдромом. Атеротромбоз. 2009;1:86–94 [Kremneva L. V., Shalaev S. V. Giperglikemiya u bol`ny`x ostry`m koronarny`m sindromom. Aterotromboz. 2009;1:86–94].
  10. Corstjens AM, van der Horst IC, Zijlstra JG, Groeneveld AB, Zijlstra F, Tulleken JE, Ligtenberg JJ. Hyperglycaemia in critically ill patients: marker or mediator of mortality? Crit Care. 2006;10 (3):216.
  11. Ritsinger V, Malmberg K, Mårtensson A, Rydén L, Wedel H, Norhammar A. Intensified insulin-based glycaemic control after myocardial infarction: mortality during 20 year follow-up of the randomised Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI 1) trial. Lancet Diabetes Endocrinol. 2014 Aug;2 (8):627–33.
  12. Malmberg K, Rydén L, Wedel H, Birkeland K, Bootsma A, Dickstein K et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005 Apr;26 (7):650–61.
  13. Какорин С. В., Карамышев Д. В., Мкртумян А. М., Нефедова Г. А. Клинико-морфологические особенности острого инфаркта миокарда у больных сахарным диабетом 2 типа. Сердце. 2014;13 (6):347–53 [Kakorin S. V., Karamy`shev D. V., Mkrtumyan A. M., Nefedova G. A. Kliniko-morfologicheskie osobennosti ostrogo infarkta miokarda u bol`ny`x saxarny`m diabetom 2 tipa. Serdcze. 2014;13 (6):347–53].
  14. Какорин С. В., Круглый, Л. Б., Мкртумян А. М. Клинико-морфологические особенности, прогноз и тактика лечения острого коронарного синдрома у больных сахарным диабетом 2 типа. Сахарный диабет. 2013;2:36–42 [Kakorin S. V., Krugly`j, L. B., Mkrtumyan A. M. Kliniko-morfologicheskie osobennosti, prognoz i taktika lecheniya ostrogo koronarnogo sindroma u bol`ny`x saxarny`m diabetom 2 tipa. Saxarny`j diabet. 2013;2:36–42].
  15. Федотова А. И., Катков В. А., Максимов И. В., Марков В. А. Опыт применения протокола инфузионной инсулинотерапии в остром периоде инфаркта миокарда у пациентов с сахарным диабетом. Сибирский медицинский журнал (г. Томск). 2011;26 (4-2):132–5 [Fedotova A. I., Katkov V. A., Maksimov I. V., Markov V. A. Opy`t primeneniya protokola infuzionnoj insulinote­rapii v ostrom periode infarkta miokarda u paczientov s saxarny`m diabetom. Sibirskij mediczinskij zhurnal (g. Tomsk). 2011;26 (4-2):132–5].
  16. Deedwania P, Kosiborod M, Barrett E, Ceriello A, Isley W, Mazzone T et al. Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2008 Mar 25;117 (12):1610–9.
  17. American Diabetes Association. Standards of medical care in diabetes – 2013. Diabetes Care. 2013 Jan;36 (Suppl 1):S11–66.
  18. Дедов И. И., Александров А. А. Проблемы острого инфаркта миокарда у больных сахарным диабетом: эхо Мюнхена. Сахарный диабет. 2008;1:4–10 [Dedov I. I., Aleksandrov A. A. Problemy` ostrogo infarkta miokarda u bol`ny`x saxarny`m diabetom: e`xo Myunxena. Saxarny`j diabet. 2008;1:4–10].
  19. Ritsinger V, Saleh N, Lagerqvist B, Norhammar A. High event rate after a first percutaneous coronary intervention in patients with diabetes mellitus. Results from the Swedish Coronary Angiography and Angioplasty Registry. Circ Cardiovasc Interv. 2015 Jun;8 (6):e002328.
  20. Gore MO, McGuire DK. The 10‑year post-trial follow-up of the United Kingdom Prospective Diabetes Study (UKPDS): cardiovascular observations in context. Diab Vasc Dis Res. 2009 Jan;6 (1):53–5.
  21. Руяткина Л. А., Руяткин Д. С., Березовская Г. А. К вопросу о приоритетах сахароснижающей терапии сахарного диабета 2 типа: сердечно-сосудистые аспекты гипогликемии. Сердце. 2013;12 (4):207–13 [Ruyatkina L. A., Ruyatkin D. S., Berezovskaya G. A. K voprosu o prioritetax saxarosnizhayushhej terapii saxarnogo diabeta 2 tipa: serdechno-sosudisty`e aspekty` gipoglikemii. Serdcze. 2013;12 (4):207–13].
  22. Недосугова Л. В. Препараты сульфонилмочевины и риск сердечно-сосудистых осложнений – «много шума из ничего»? Фарматека. 2010;3:22–31 [Nedosugova L. V. Preparaty` sul`fonilmocheviny` i risk serdechno-sosudisty`x oslozhnenij – «mnogo shuma iz nichego»? Farmateka. 2010;3:22–31].
  23. Руяткина Л. А., Сорокин М. Ю. Глимепирид в современной гипогликемизирующей терапии: безопасность и эффективность. Сахарный диабет. 2012;2:89–97 [Ruyatkina L. A., Sorokin M. Yu. Glimepirid v sovremennoj gipoglikemiziruyushhej terapii: bezopasnost` i e`ffektivnost`. Saxarny`j diabet. 2012;2:89–97].
  24. Baranyai T, Nagy CT, Koncsos G, Onódi Z, Károlyi-Szabó M, Makkos A et al. Acute hyperglycemia abolishes cardioprotection by remote ischemic perconditioning. Cardiovasc Diabetol. 2015 Nov 18;14:151.
  25. Inzucchi SE, Matthews DR. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015 Aug;38 (8):e128–9.
  26. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998 Sep 12;352 (9131):854–65.
  27. Bailey CJ, Campbell IW, Chan JCN, Davidson JA, Howlett HCS, Ritz P. Metformin the gold standard: a scientific handbook. Chichester (UK): Wiley & Sons ltd, 2007. – 272p.
  28. Alessi MC, Juhan-Vague I. PAI-1 and the metabolic syndrome: the links, causes and consequences. Arterioscler Thromb Vasc Biol. 2006 Oct;26 (10):2200–7.
  29. Lexis CP, van der Horst IC, Lipsic E, Wieringa WG, de Boer RA, van den Heuvel AF et al. Effect of metformin on left ventricular function after acute myocardial infarction in patients without diabetes: the GIPS-III randomized clinical trial. JAMA. 2014 Apr 16;311 (15):1526–35.
  30. Bonora E. Postprandial peaks as a risk factor for cardiovascular disease: epidemiological perspectives. J Clin Pract Suppl. 2002 Jul;129:5–11.
  31. Ceriello A, Davidson J, Hanefeld M, Leiter L, Monnier L, Owens D et al. Postprandial hyperglycaemia and cardiovascular complications of diabetes: an update. Nutr Metab Cardiovasc Dis. 2006 Oct;16 (7):453–6.
  32. Климонтов В. В., Мякина Н. Е. Вариабельность гликемии при сахарном диабете: инструмент для оценки качества гликемического контроля и риска осложнений. Сахарный диабет. 2014;2:76–82 [Klimontov V. V., Myakina N. E. Variabel`nost` glikemii pri saxarnom diabete: instrument dlya oczenki kachestva glikemicheskogo kontrolya i riska oslozhnenij. Saxarny`j diabet. 2014;2:76–82].
  33. Su G, Mi S, Li Z, Tao H, Yang H, Zheng H. Prognostic value of early in-hospital glycemic excursion in elderly patients with acute myocardial infarction. Cardiovasc Diabetol. 2013 Feb 11;12:33.
  34. Gohbara M, Hibi K, Mitsuhashi T, Maejima N, Iwahashi N, Kataoka S et al. Glycemic variability on continuous glucose monitoring system correlates with non-culprit vessel coronary plaque vulnerability in patients with first-episode acute coronary syndrome - optical coherence tomography study. Circ J. 2016;80 (1):202–10.
  35. Asanuma H, Kitakaze M. Glycemic variability predicts rapid progression of non-culprit lesions in patients with acute coronary syndrome. Circ J. 2015;79 (10):2114–5.
  36. Deacon CF, Mannucci E, Ahrén B. Glycaemic efficacy of glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors as add-on therapy to metformin in subjects with type 2 diabetes – a review and meta-analysis. Diabetes Obes Metab. 2012 Aug;14 (8):762–7.
  37. Nauck MA, Meininger G, Sheng D, Terranella L, Stein PP. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, compared with the sulfonylurea, glipizide, in patients with type 2 diabetes inadequately controlled on metformin alone: a randomized, double-blind, non-inferiority trial. Diabetes Obes Metab. 2007 Mar;9 (2):194–205.
  38. Руяткина Л. А., Сорокин М. Ю. Выбор глиптинов в разных клинических ситуациях – комментарии к портретам пациентов. Фарматека. 2012;20:89–95 [Ruyatkina L. A., Sorokin M. Yu. Vy`bor gliptinov v razny`x klinicheskix situacziyax – kommentarii k portretam paczientov. Farmateka. 2012;20:89–95].
  39. Hage C, Brismar K, Efendic S, Lundman P, Rydén L, Mellbin L. Sitagliptin improves beta-cell function in patients with acute coronary syndromes and newly diagnosed glucose abnormalities – the BEGAMI study. J Intern Med. 2013 Apr;273 (4):410–21.
  40. Brenner C, Adrion C, Grabmaier U, Theisen D, von Ziegler F, Leber A et al. Sitagliptin plus granulocyte colony-stimulating factor in patients suffering from acute myocardial infarction: a double-blind, randomized placebo-controlled trial of efficacy and safety (SITAGRAMI trial). Int J Cardiol. 2016 Feb 15;205:23–30.
  41. White WB, Cannon CP, Heller SR, Nissen SE, Bergenstal RM, Bakris GL et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013 Oct 3;369 (14):1327–35.
  42. Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B et al.. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013 Oct 3;369 (14):1317–26.
  43. Green JB, Bethel MA, Armstrong PW, Buse JB, Engel SS, Garg J et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015 Jul 16;373 (3):232–42.
  44. Bentley-Lewis R, Aguilar D, Riddle MC, Claggett B, Diaz R, Dickstein K et al. Rationale, design, and baseline characteristics in Evaluation of lixisenatide in acute coronary syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo. Am Heart J. 2015 May;169 (5):631–638.e7.
  45. Zannad F., Cannon CP, Cushman WC, et al. Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicenter, randomized, double-blind trial. Lancet 2015; 385: 2067–76.
  46. Fisman EZ, Tenenbaum A. Antidiabetic treatment with gliptins: focus on cardiovascular effects and outcomes. Cardiovasc Diabetol. 2015 Sep 29;14:129.
  47. Петунина Н. А., Терехова А. Л. Алоглиптин – новый представитель класса ингибиторов ДПП-4. Ожирение и метаболизм. 2014;4:25–31 [Petunina N. A., Terexova A. L. Alogliptin – novy`j predstavitel` klassa ingibitorov DPP-4. Ozhirenie i metabolizm. 2014;4:25–31].
  48. White W.B., Kupfer S., Zannad F., Mehta C.R.,Wilson C.A., Lei K. et al. Cardiovascularmortality in patients with type 2 diabetes and recent acute coronary syndromes from the EXAMINE trial. Diabetes Care 2016;39:1267–1273.
  49. Huo X, Gao L, Guo L, Xu W, Wang W, Zhi X et al. Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. Lancet Diabetes Endocrinol. 2016 Feb;4 (2):115–24.
  50. Song SH. Early-onset type 2 diabetes: high lifetime risk for cardiovascular disease. Lancet Diabetes Endocrinol. 2016 Feb;4 (2):87–8.
  51. Tancredi M, Rosengren A, Svensson AM, Kosiborod M, Pivodic A, Gudbjörnsdottir S et al. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015 Oct 29;373 (18):1720–32.
  52. Lee C, Joseph L, Colosimo A, Dasgupta K. Mortality in diabetes compared with previous cardiovascular disease: a gender-specific meta-analysis. Diabetes Metab. 2012 Nov;38 (5):420–7.
  53. Arnetz L, Ekberg NR, Alvarsson M. Sex differences in type 2 diabetes: focus on disease course and outcomes. Diabetes Metab Syndr Obes. 2014 Sep 16;7:409–20.
  54. Szalat A, Raz I. Gender-specific care of diabetes mellitus: particular considerations in the management of diabetic women. Diabetes Obes Metab. 2008 Dec;10 (12):1135–56.
Ruyatkina L. A., Ruyatkin D. S., Ovsyannikova A. K. On the issue of carbohydrate
metabolic control in acute coronary syndrome with dysglycemia. Russian Heart Journal. 2016;15 (4):265–271

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