The CREATE-ECLA Randomized Controlled TrialThe CREATE-ECLA Trial Group Investigators* See also pp 427 and 489.

Hypoglycaemia occurs more frequently between 21.00 and 09.00 h in hospitalized patients receiving treatments that can cause hypoglycaemia. This may be related to insufficient carbohydrate intake during this period, and is potentially preventable by changes in catering practice.

SUMMARY Total urinary catecholamines and plasma free fatty acids (FFA) were estimated serially in 50 patients with myocardial infarction (A) and in 27 cases of angina (B). A group of 24 normal healthy subjects (C) were also studied as controls. Catecholamines were significantly high (p < 0 001) in group A in the first 48 hours after infarction as compared to group C. Group B did not show significant variation from the normals (C). FFA also tended to increase only in group A in the first 48 hours. Both the parameters had returned to normal by 72 hours. The significance of the findings is discussed.Considerable interest has been shown lately in the role of catecholamines and free fatty acids (FFA) in ischaemic heart disease. These have been characterised as important prognostic indicators of the severity of myocardial damage (Oliver et al., 1968;Januszewicz et al., 1968;Hayashi et al., 1969;McDonald et al., 1969;Taylor et al., 1969;Rutenberg et al., 1969). These biochemical measurements probably reflect generalised metabolic response to the stress of ischaemia. Cases of myocardial infarction and ischaemia without infarction (angina) differ primarily in the extent and degree of damage to the heart. The pathogenesis in both these clinical entities is apparently the same. The possible significance of catecholamines in the development of angina has been reviewed by Black and Prichard (1973). It is widely assumed that angina follows an imbalance in the oxygen supply and demand. Catecholamines increase demand by raising heart rate and force of contraction of the heart and by stimulating cardiac metabolism, commonly referred to as an oxygenwasting effect (Sarnoff et al., 1965). For example, the effect of raised FFA levels after isoprenaline infusion is to raise myocardial oxygen consumption significantly more than the effect of heart work alone (Mj0s, 1971). Accordingly, we estimated total urinary catecholamine excretion and plasma FFA in cases of acute myocardial infarction and angina. A group of normal, healthy, age-matched subjects were also studied for comparison. The results are reported.

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