Insulin in Acute Coronary Syndrome: a Narrative Review with Contemporary Perspectives

Michael C Y Nam; Christopher D Byrne; Juan Carlos Kaski; Kim Greaves

doi:10.1007/s10557-016-6679-9

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Insulin in Acute Coronary Syndrome: a Narrative Review with Contemporary Perspectives

Journal article

Open access

Peer reviewed

Insulin in Acute Coronary Syndrome: a Narrative Review with Contemporary Perspectives

Michael C Y Nam, Christopher D Byrne, Juan Carlos Kaski and Kim Greaves

Cardiovascular Drugs and Therapy, Vol.30(5), pp.493-504

2016

DOI: https://doi.org/10.1007/s10557-016-6679-9

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Abstract

insulin

myocardial blood flow reserve

acute coronary syndrome

coronary artery disease

The role of insulin in the treatment of acute coronary syndrome (ACS) has been widely studied over the past 100 years. The current indication for its use in this context is the treatment of hyperglycemia, irrespective of diabetes, which is associated with adverse outcome. Initial theories proposed that glucose was beneficial in the context of myocardial ischemia and insulin was required to enable glucose cell uptake. However, studies testing this hypothesis with routine insulin administration during ACS have produced disappointing results and research interest has therefore declined. We propose that the less well known but important vasodilator effect of insulin has been overlooked by some of these studies and warrants further consideration. Previous reports have shown that hyperinsulinemic euglycaemia improves myocardial blood flow reserve. With this in mind, this review considers the role of insulin in the context of ACS from the perspective of a vasodilator rather than a metabolic modulator. We discuss the importance of time to treatment, dosage of insulin administered, problems with hypoglycaemia and insulin resistance, and how they may have affected the outcomes of the major trials. Finally, we propose new study designs that allow determination of the optimal vasodilator conditions for the use of insulin as adjunctive pharmacotherapy during myocardial ischaemia.

Details

Title: Insulin in Acute Coronary Syndrome: a Narrative Review with Contemporary Perspectives
Authors: Michael C Y Nam (Author) - University of the Sunshine Coast
Christopher D Byrne (Author) - University of Southampton, United Kingdom
Juan Carlos Kaski (Author) - University of London, United Kingdom
Kim Greaves (Author) - University of the Sunshine Coast
Publication details: Cardiovascular Drugs and Therapy, Vol.30(5), pp.493-504
Publisher: Springer New York LLC
Date published: 2016
DOI: 10.1007/s10557-016-6679-9
ISSN: 0920-3206
Copyright note: Copyright © 2016 Springer New York LLC. The author's accepted version is reproduced here in accordance with the publisher's copyright policy. The final publication is available at Springer via http://dx.doi.org/10.1007/s10557-016-6679-9
Organisation Unit: Faculty of Science, Health, Education and Engineering; University of the Sunshine Coast, Queensland
Language: English
Record Identifier: 99450428802621
Output Type: Journal article

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Collaboration types: Domestic collaboration; International collaboration
Web Of Science research areas: Cardiac & Cardiovascular Systems; Pharmacology & Pharmacy

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