The survey revealed that diabetes is known to be present in about a third of both acute and stable patients with CAD. When an oral glucose tolerance test was performed, another 15% of acute patients and 10% of stable patients were shown to have diabetes that was not yet recognised.
Furthermore, about a quarter had abnormal fasting glucose or impaired glucose tolerance. Thus, the majority of patients with acute or chronic coronary disease have an abnormal glucose metabolism. A coronary event often is thefirst manifestation of diabetes. The outcome of this survey underlines the importance to include diagnostic testing of glucose abnormalities when investigating patients with CAD. An OGTT is needed for full disclosure of the actual glucometabolic state. One would have missed about two thirds of patients with abnormalities using fasting plasma glucose(FPG) only.
The presence of glucometabolic disturbances should intensify the use of various secondary preventive efforts. In accordance with guidelines for CVD prevention, this survey revealed high prescription rates for anti-platelets, lipid lowering drugs, beta-blockers, and ACE-inhibitors in comparison with previous surveys. ACE-inhibitors were prescribed more often in patients with previously known diabetes than other patients in this survey.
The survey confirmed that patients with CAD and known diabetes are at high risk for mortality and cardiovascular events and demonstrated that patients with newly diagnosed diabetes are at intermediate risk. Although impaired glucose regulation (IGR) could not be identified as an independent predictor for adverse outcomes at 1-year follow-up, it has been shown by several studies that IGR markedly increases the risk of developing diabetes. Interventions aiming at delaying or preventing the onset of diabetes may prove beneficial for patients with IGR.
- The majority of patients with acute orchronic CAD have an abnormal glucosemetabolism;
- Diagnostic testing of glucose abnormalitieswhen investigating patients withCAD is of utmost importance;
- The prescription rate for CVD preventivemedication was high compared to previoussurveys;
- IGR could not be identified as an independentpredictor for adverse outcomeswithin 1 year, but interventions aimingat delaying or preventing the onset ofdiabetes may prove beneficial for patientswith IGR.
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