1. Hyperglycemia and Acute Coronary Syndromes

2. Cardiovascular disease and diabetes Bell DSH. Diabetes Care. 2003;26:2433-41. Centers for Disease Control (CDC). www.cdc.gov. T2DM = type 2 diabetes mellitus Cardiovascular complications of T2DM ~65% of deaths are due to CV disease Coronary heart disease deaths  2- to 4-fold Stroke risk  2- to 4-fold Heart failure  2- to 5-fold

3. Abnormal glucose metabolism in CAD n = 2107 inpatients with acute CAD; n = 2854 outpatients with stable CAD Bartnik M et al. Eur Heart J. 2004;25:1880-90. Total patients (%) OGTT* *n = 1920 without known diabetes OGTT = oral glucose tolerance test; IGT = impaired glucose tolerance; IFG = impaired fasting glucose Known diabetes 58 51 IGTIFGNew DM Patients* (%)

4. ADA criteria for IGT and T2DM 126 mg/dL 100 mg/dL* 140 mg/dL 200 mg/dL *WHO: 110 mg/dL American Diabetes Association (ADA). Diabetes Care. 2007;30(suppl 1)S4-41. World Health Organization (WHO). www.who.int/diabetes. Fasting plasma glucose 2-Hour plasma glucose during 75-g OGTT T2DM IGT Normal T2DM IGT Normal

5. New-onset hyperglycemia linked to highest rate of in-hospital mortality N = 2030 hospital patients Umpierrez GE et al. J Clin Endocrinol Metab. 2002;87:978- 82. *P < 0.01 vs normoglycemia and known diabetes ICU patientsNon-ICU patients * *

6. Admission glucose in AMI associated with mortality, independent of T2DM diagnosis N = 141,680 hospitalized with AMI Kosiborod M et al. Circulation. 2005;111:3078-86. Admission glucose (mg/dL) 30 days 1 year Mortality (%) AMI = acute myocardial infarction 0 10 20 30 40 50 60 ≤110>110- 140 >140- 170 >170- 240 >240 DiabetesNo diabetes 0 10 20 30 40 50 60 ≤110>110- 140 >140- 170 >170- 240 >240

7. Stress hyperglycemia in AMI: Association with mortality risk in patients without known diabetes Reference Hyperglycemia definition (mg/dL) 013 Unadjusted RR of in-hospital mortality after MI* Capes SE et al. Lancet. 2000;355:773-8. *vs patients with normoglycemia 1991 O’Sullivan 1991 >144 1979 Lewandowicz 1979 ≥121 1981 Soler 1981 ≥110 1986 Oswald 1986 ≥144 1989 Bellodi 1989>121 1975 Ravid 1975>121 1989 Sewdarsen 1989 ≥144 Pooled 123456789101112

8. Baseline fasting plasma glucose levels predict HF hospitalization in high-risk patients  23% in HF hospitalization per  18 mg/dL glucose in patients with no known diabetes Log rank P < 0.001 Held C et al. Circulation. 2007;115;1371-5. ONTARGET/TRANSCEND; N = 31,546 with CVD or DM + end-organ damage Proportion with incident HF hospitalization 12001000800600 Follow-up (days) 4002000 0.0 0.01 0.02 0.03 0.04 0.05 0.06 Normal low Normal high IFG New DM DM

9. *Multivariate analysis  Glucose (24 hr vs baseline) ≥30 mg/dL decrease No change to <30 mg/dL decrease Increase Admission glucose and glucose change within 24 hours predict mortality risk Goyal A et al. Eur Heart J. 2006;27:1289-97. N = 1469 with AMI (n = 1219 without DM) 30-day mortality (%) Baseline glucose (mg/dL) <125125–<140140–<170≥170 0  9% in 30-day mortality per  11 mg/dL glucose in first 24 hr (P = 0.002)*