Diabetes has "powerful impact" on survival after MI

המידע באדיבות medicontext.co.il
Last Updated: 2001-08-06 15:14:05 EDT (Reuters Health)

By Michelle Cooke

WESTPORT, CT (Reuters Health) – Diabetes substantially increases the risk of death after myocardial infarction (MI), especially in women, Massachusetts researchers report in the August issue of Diabetes Care.

"Our results highlight the severe detrimental impact of diabetes at all stages of heart disease, including after an MI," study director Dr. Kenneth J. Mukamal told Reuters Health. "I was not surprised that diabetes has such a powerful impact on survival–as powerful as a previous infarction–because studies in patients without heart disease and with unstable angina have shown similar results."

Dr. Mukamal, of Beth Israel Deaconess Medical Center, in Boston, and multicenter colleagues examined the impact of diabetes on long-term survival after MI among nearly 2000 early survivors of acute MI enrolled in the prospective Determinants of Myocardial Infarction Onset Study. Three hundred ninety-nine of the patients were previously diagnosed with diabetes.

After a mean follow-up of 3.7 years, the investigators found that diabetes increased the risk of death by nearly twofold. The magnitude of this association was not affected by type of treatment, duration of diabetes or patient subgroup. However, the effect of diabetes on survival was stronger in women than in men (hazard ratio 2.7 versus 1.3).

The findings agree with prior studies on diabetes and survival after acute MI.

"Patients with diabetes need aggressive treatment of cardiac risk factors to prevent MI, including maintaining LDL cholesterol below 100 if possible," Dr. Mukamal said. "We also need further research on strategies to lower mortality among diabetic patients who sustain infarctions, including the role of early bypass grafting and glucose-insulin infusions."

Dr. Mukamal added that physicians should be aware that guidelines for treating cardiovascular risk factors in diabetic patients change often. "For example," he explained, "guidelines for managing cholesterol problems in patients with diabetes changed within the last few months."

Diabetes Care 2001;24:1422-1427.

-Westport Newsroom 203 319 2700

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