"Despite all the advances and mortality-reducing therapy that have been introduced for the management of ACS, the benefit of those is offset by the increasing number of patients who are diabetic in our population," stated senior author on the study, Dr Elliott Antman  "We have two competing processes: we're actually getting better in terms of our therapies for ACS, but at the same time the diabetes epidemic is racing on. And we have evidence here that being a diabetic is associated with short- and long-term mortality, which underscores the need for urgent attention to diabetes in several regards."

At 30 days and one year, mortality was significantly higher for diabetic patients than nondiabetic patients, regardless of whether they'd experienced UA/NSTEMI or STEMI. While other studies have shown differences in mortality for diabetics vs nondiabetics, this analysis provides some of the most compelling data so far — that even patients getting the best treatments for ACS have worse outcomes. Indeed, prehospitalization, in hospital, and at discharge, diabetics were significantly more likely than nondiabetics to get guideline-recommended therapy, yet outcomes were worse.

"In addition to all the various things that we do for ACS now, we need to redouble our efforts to find improved therapies for diabetics in particular," Antman said. "That may require new drugs or entirely new approaches than we've taken in nondiabetics."

When authors compared cumulative incidence mortality curves for patients with and without diabetes and with STEMI or UA/NSTEMI, they found that while diabetics with STEMI, not surprisingly, had the highest risk of dying at one year, the risk for nondiabetics with STEMI at one year was very similar to that of diabetics who had UA/NSTEMI at baseline.

"Mortality really continues on a sharp slope for the UA/NSTEMI diabetic, indicating that our job is not done when you get the patient out of the hospital and past the first 30 days," Antman explained. "If we don't pay attention to what's happening between the end of the first month and the ensuing 11 months, those patients will be at virtually the same mortality risk as though they had come in with a more serious form of ACS — STEMI — and not been a diabetic. That's information that I don't think has been appreciated in the past."

Dr Sean M Donahoe (Brigham and Women's Hospital, Boston, MA) et al report their findings in the August 15, 2007 issue of the Journal of the American Medical Association.

===================================================

DID YOU KNOW:
U.S. Death Rate Hits All-Time Low: The U.S. death rate fell to a historic low in 2004 and the life expectancy at birth hit a record high, according to the National Center for Vital Statistics.  Final totals for the year show 2,397,615 deaths and an age-adjusted death rate of 800.8 deaths per 100,000 people.  That was 50,673 fewer deaths than in 2003 and represented the largest single-year decline in raw death counts since 1938, when deaths fell by 69,036 from the previous year. At the same time, life expectancy at birth hit 77.8 years, continuing an increasing trend in the population as a whole and among both blacks and whites, according to the agency, part of the CDC. The "remarkable reduction in the risk of dying," the report said, "has been driven mostly by net decreases in heart disease, cancer, stroke, chronic lower respiratory diseases, and influenza and pneumonia."  National Vital Statistics Reports - Miniño AM et al. "Deaths: Final Data for 2004." NVSR 2007; 55(19)

==================

Advertisement
You've probably heard the term "low glycemic" bandied about in the media and in discussions about weight loss. You may have even come across some food products labeled as such.
It's All About Sugar
"Glycemic" simply means "relating to sugar." The higher the glycemic impact of a food the greater and more rapid its effect on your blood sugar when you eat it. High blood sugar can sabotage your weight-management and better health efforts. Eating lower glycemic foods is definitely the way to go.

Atkins Advantage(r) nutrition bars and shakes are low-glycemic impact and substantiated by clinical testing. A controlled carbohydrate, low sugar way of eating provides you with a powerhouse of nutrients to support your health and stabilized blood-sugar levels. Click Here for more information