Acute coronary syndromes (ACS) is a term used to describe a group of conditions resulting from acute myocardial ischemia (insufficient blood flow to heart muscle) and ranging from unstable angina (increasing, unpredictable chest pain) to myocardial infarction (heart attack). The conditions are related to varying degrees of narrowing or blockage of single or multiple coronary arteries that provide blood, oxygen, and nutrients to the heart. This life-threatening disorder is a major cause of emergency medical care and hospitalization. Coronary artery disease (CAD) remains the leading cause of death in the United States. One of every 5 deaths is due to CAD, accounting for more than 452 000 deaths in 2006. The August 15, 2007, issue of JAMA includes an article indicating that diabetes is a significant risk factor for ACS and adds to the overall burden of cardiovascular disease. This article highlights the importance of aggressive strategies to treat diabetes in patients with heart disease.