Biomarkers in acute coronary syndromes and their role in diabetic patients

Diabetic patients with acute coronary syndromes are at high risk
for cardiovascular complications but risk stratification in these
patients remains challenging. Regularly, diabetic patients have a
less typical clinical presentation, which could lead to delayed
diagnosis and subsequent delayed initiation of treatment. Since
diabetic patients derive particular benefit from aggressive
anti-platelet therapy, early diagnostic and therapeutic risk
stratification of these patients is of critical importance to
improve their adverse outcome. Although the electrocardiogram
remains a pivotal diagnostic tool in the evaluation of patients
suspected of having an acute coronary syndrome, only significant
STsegment changes provide reasonable prognostic information.
Therefore, repeated assessment of circulating protein biomarkers
represents a valuable diagnostic tool for improving efficacy and
safety of decision-making in these patients. The combined use of
biomarkers reflecting distinct pathophysiological aspects, such as
myocardial necrosis, vascular inflammation, oxidative stress and
neurohumoral activation, may significantly improve triage of
patients with chest pain. These tools may identify those patients
that are at particularly high risk for short-term and/or long-term
cardiovascular events. Eventually, tailored medical and
interventional treatment of diabetic patients should help to
prevent these cardiac events in a cost-effective manner.