Glucose, insulin, and coronary heart disease: reply

We appreciate that our articles on potentially negative effects of insulin treatment have attracted interest that initiates a discussion on possible explanations to this seemingly unexpected finding. We agree that the analysis of inflammatory markers and cytokines may shed some further light on this issue. Such studies are under way in a fairly large subgroup of the DIGAMI 2 patients. That insulin may relate to increased release of inflammatory cytokines in diabetic patients with coronary artery disease has recently been reported by Antoniades et al. 1 We do, however, not believe that, as suggested ‘the negative …

[1]  L. Rydén,et al.  The impact of glucose lowering treatment on long-term prognosis in patients with type 2 diabetes and myocardial infarction: a report from the DIGAMI 2 trial. , 2007, European heart journal.

[2]  L. Rydén,et al.  Glucose lowering treatment in patients with coronary artery disease is prognostically important not only in established but also in newly detected diabetes mellitus: a report from the Euro Heart Survey on Diabetes and the Heart. , 2007, European heart journal.

[3]  H. Schunkert,et al.  Glucose-lowering therapy after myocardial infarction: more questions than answers. , 2007, European heart journal.

[4]  H. Gerstein,et al.  Rationale, design, and baseline characteristics for a large international trial of cardiovascular disease prevention in people with dysglycemia: the ORIGIN Trial (Outcome Reduction with an Initial Glargine Intervention). , 2008, American heart journal.

[5]  S. Yusuf,et al.  Rationale, design, and baseline characteristics for a large international trial of cardiovascular disease prevention in people with dysglycemia: the ORIGIN Trial (Outcome Reduction with an Initial Glargine Intervention). , 2008, American heart journal.

[6]  U. Das.  Glucose, insulin, and acute myocardial infarction. , 2006, European heart journal.

[7]  P. Armstrong,et al.  Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the CARDINAL study. , 2006, European heart journal.

[8]  J Herlitz,et al.  Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. , 2005, European heart journal.

[9]  R. Einspanier,et al.  Insulin attenuates the systemic inflammatory response in endotoxemic rats. , 2004, Endocrinology.