Issue 121 Item 10 ESC: OGTT Needed for Most Heart Attack Patients

Most patients who present at emergency cardiac care units with a heart attack have abnormal glucose metabolism, and most of those patients are diabetic — the majority undiagnosed. "I think we should be giving an oral glucose tolerance test as a routine procedure in coronary care units," said Dr. Lars Ryden, professor of cardiology at the Karolinska Hospital, in Stockholm, Sweden.

At a press briefing at the 24th annual congress of the European Society of Cardiology (ESC), Dr. Ryden, formerly president of the ESC, said that about 20 percent of myocardial infarction patients are known to be diabetics. But about 65 percent of the rest of the patients admitted during the acute heart attack have abnormal glucose metabolism — and half of that group would fit the definition for having diabetes.

Dr. Ryden and colleagues studied 181 patients, average age was 63; about two-thirds of them were men. Their blood glucose was measured upon admission and their fasting blood glucose was analyzed daily during their hospital stay.

"Abnormal blood glucose levels seen in heart attack patients has been considered something that occurs with the stress of myocardial infarction," Dr. Ryden said. He said that tests taken in the hospital among these patients indicate a large percentage actually have undiagnosed diabetes.

He said that 35 percent of the study participants had impaired glucose tolerance at discharge and 40 percent still had impaired glucose tolerance at three months. Another 31 percent were found to have previously undiagnosed diabetes mellitus at discharge; 25 still fulfilled diabetes criteria at three months among these previously undiagnosed patients.

"Disturbed glucose metabolism is considerably more common among patients with acute coronary syndromes than previously known," he said.

Although easy to detect, Dr. Ryden suggested that many patients may be reaching the hospital in urgent states of undiagnosed diabetes because of a lack of communication between endocrinologists — who treat diabetics but may not be that familiar with cardiology — and cardiologists — who may not be as familiar with diabetes.

In addition to performing diabetes testing on admitted heart attack patients, Dr. Ryden said, "Even better would be to detect impaired glucose tolerance before the patient gets a manifestation of coronary artery disease such as a heart attack."

He suggested that population screening to determine undetected diabetes and impaired glucose tolerance should be considered.