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In Reply: In response to Drs Srinivasan and Bhagra, we agree that aggressive modification of risk factors that may result in prolonged survival should be the main long-term management goal in patients who present with unstable ischemic heart disease. An emphasis on secondary prevention with medical therapy is vital for all patients, and perhaps even more so for patients with diabetes. New approaches to ensure adherence to clinical guideline recommendations for proven therapies may be of benefit.

We reported and adjusted for medications at discharge to ensure that the increased mortality among patients with diabetes following the index ACS event was not related to differences in prescription patterns. Patients with diabetes were less likely to be discharged while taking a β-blocker compared with those without diabetes (65.4% vs 70.5%, P < .001). This difference may be due to fears of masking the sympathetic response to hypoglycemia or increasing insulin resistance. However, . . . [Full Text of this Article]

Sean M. Donahoe, MD
Cornell University Medical Center
New York, New York

Garrick C. Stewart, MD; Elliott M. Antman, MD
eantman@rics.bwh.harvard.edu
Brigham and Women's Hospital
Boston, Massachusetts

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Diabetes and Mortality Risk After Acute Coronary Syndromes
Manivannan Srinivasan and Sumit Bhagra
JAMA. 2007;298(20):2367.
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Diabetes and Mortality Risk After Acute Coronary Syndromes
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JAMA. 2007;298(20):2367-2368.
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