Pharmacological cardioprotection in diabetes

Acute coronary syndrome (ACS) in patients with diabetes continues to present clinical management challenges despite recent improvements in the management of ACS. The diabetic myocardium is more vulnerable to ischemia–reperfusion injury than non-diabetic myocardium and the diabetic patient more likely to develop complications, significant morbidity and death following ACS. Currently, ACS management of diabetic and non-diabetic patients is not sufficiently differentiated to address the additional risk arising from ACS in a diabetic. Here we review the evidence for routine aspects of diabetic management such as glucose control in the context of ACS, and suggest that additional benefit may be derived by tailoring and pre-purposing antiglycemic medications during acute myocardial infarction to make best use of their pleotropic potential as cardioprotective agents. Practice points