Issue 111 Item 5 66% of Heart Attack Patients have Undiagnosed Diabetes or PreDi

Testing patients who have had heart attacks for signs of diabetes before they leave the hospital may identify those with the highest risk of future heart attacks, researchers report. Researchers found that many people hospitalized for a heart attack have undiagnosed diabetes or prediabetes, a term coined to describe the millions of overweight and obese people who have blood sugar levels suggesting an elevated risk of full-blown diabetes.

Because diabetes increases the risk of death from heart disease, the study "opens up new possibilities for preventing relapses of (heart attack) and untimely death,"said lead author Dr. Lars Ryden, of Karolinska Hospital in Stockholm, Sweden.

Medications, exercise and diet changes, all of which can restore normal glucose levels, may reduce the risk of heart attacks in patients who have already had a heart attack, he said.

Patients with prediabetes have been shown to be at higher risk of heart disease, and among people who have a heart attack, those who have diabetes are more likely to die, the report indicates.

Conditions that can lead to diabetes often go undetected, however, so the investigators, under the leadership of Dr. Anna Norhammar, set out to see how many heart attack patients have blood sugar irregularities even though they had not been diagnosed with diabetes.

The testing revealed that a substantial percentage of 181 heart attack patients in the study had blood sugar abnormalities, the researchers report in the June 22nd issue of the medical journal The Lancet. At hospital discharge, 31% of patients were diagnosed with diabetes and 35% with signs of prediabetes. The abnormalities were not temporary: 3 months later, 25% of patients had diabetes and 40% had signs of prediabetes.

Based on the results of the study, the authors recommend that heart attack patients be tested for signs of diabetes before being discharged from the hospital.

The percentage of heart attack patients with previously undiagnosed diabetes or impaired glucose intolerance is higher than expected, writes Dr. Steven M. Haffner, of the University of Texas Health Science Center at San Antonio, in an accompanying editorial. The Lancet 2002;359:2127-2128, 2140-2144.