[ProCOR] Diabetes and Mortality Following Acute Coronary Syndromes
[The study below demonstrates an association between diabetes at time of presentation with acute coronary syndromes and all-cause mortality at 30 days and at one year.]
Title: Diabetes and Mortality Following Acute Coronary Syndromes
Author: SM Donahoe, GC Stewart, et al.
Reference: JAMA 2007; 298(7): 765-75,
http://jama.ama-assn.org/cgi/content/abstract/298/7/765
Reviewer: Carlos Mendoza Montano, PhD, ProCor contributing editor, APRECOR, Guatemala, e-mail: projhouse@intelnet.net.gt
Problem addressed: The presence of high blood glucose levels, diabetes mellitus or both contributes to more than three million cardiovascular deaths worldwide each year. With the increase in obesity, insulin resistance and the metabolic syndrome, the worldwide prevalence of diabetes is expected to double by the year 2030. This burgeoning diabetes epidemic will increase the burden of CVD attributable to diabetes, but the independent association of diabetes with mortality following acute coronary syndromes (ACS) in the present era of coronary care remains uncertain.
Purpose of study: To evaluate the independent effect of diabetes on mortality following ACS at 30 days and one year from a large clinical trial database spanning the full spectrum of ACS.
Location of study: Conducted in the US using data from around the world.
Study design: A subgroup analysis of patients with diabetes enrolled in randomized clinical trials that evaluated ACS therapies. Patients with ACS in 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials from 1997-2006 were pooled, including 62,036 patients (46,577 with ST-segment elevation myocardial infarction [STEMI] and 15,459 with unstable angina/non-STEMI [UA/NSTEMI]), of whom 10,613 (17.1%) had diabetes. A multivariable model was constructed to adjust for baseline characteristics, aspects of ACS presentation, and treatments for the ACS event. The study had as a main outcome measures the mortality at 30 days and 1 year following ACS among patients with diabetes vs patients without diabetes.
Results/Findings: Mortality at 30 days was significantly higher among patients with diabetes than without diabetes presenting with UA/NSTEMI (2.1% vs 1.1%, P< 0.001) and STEMI (8.5% vs 5.4%, P< 0.001). After adjusting for baseline characteristics and features and management of the ACS event, diabetes was independently associated with higher 30-day mortality after UA/NSTEMI (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.24-2.56) or STEMI (OR, 1.40; 95% CI, 1.24-1.57). Diabetes at presentation with ACS was associated with significantly higher mortality one year after UA/NSTEMI (hazard ratio [HR], 1.65; 95% CI, 1.30-2.10) or STEMI (HR, 1.22; 95% CI, 1.08-1.38). By one year following ACS, patients with diabetes presenting with UA/NSTEMI had a risk of death that approached patients without diabetes presenting with STEMI (7.2% vs 8.1%).
Comments: This study demonstrates a statistically robust association between diabetes at time of presentation with ACS and all-cause mortality at 30 days and at one year, even after adjusting for baseline characteristics as well as features and management of the index event. Despite advances in the treatment of ACS, the magnitude of excess mortality among patients with diabetes was considerable. The magnitude of risk conferred by diabetes following ACS demands a major research effort to reduce the influence of diabetes on coronary artery disease. Reducing coronary risk from diabetes requires a multi-factorial approach to manage all atherogenic influences. The authors of this article suggest a long-term, targeted, intensive use of proven therapies for the traditional coronary risk factors which should be widely promoted for patients with diabetes, particularly following ACS. Collaboration between medical societies, national health care organizations, and industry will be vital to halt the epidemic of diabetes-related cardiovascular disease.
Additional References:
1. Danaei G, Lawes CM, Vander Hoorn S, Murray CJ, Ezzati M. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk.
2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27(5): 1047-53.
Title: Diabetes and Mortality Following Acute Coronary Syndromes
Author: SM Donahoe, GC Stewart, et al.
Reference: JAMA 2007; 298(7): 765-75,
http://jama.ama-assn.org/cgi/content/abstract/298/7/765
Reviewer: Carlos Mendoza Montano, PhD, ProCor contributing editor, APRECOR, Guatemala, e-mail: projhouse@intelnet.net.gt
Problem addressed: The presence of high blood glucose levels, diabetes mellitus or both contributes to more than three million cardiovascular deaths worldwide each year. With the increase in obesity, insulin resistance and the metabolic syndrome, the worldwide prevalence of diabetes is expected to double by the year 2030. This burgeoning diabetes epidemic will increase the burden of CVD attributable to diabetes, but the independent association of diabetes with mortality following acute coronary syndromes (ACS) in the present era of coronary care remains uncertain.
Purpose of study: To evaluate the independent effect of diabetes on mortality following ACS at 30 days and one year from a large clinical trial database spanning the full spectrum of ACS.
Location of study: Conducted in the US using data from around the world.
Study design: A subgroup analysis of patients with diabetes enrolled in randomized clinical trials that evaluated ACS therapies. Patients with ACS in 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials from 1997-2006 were pooled, including 62,036 patients (46,577 with ST-segment elevation myocardial infarction [STEMI] and 15,459 with unstable angina/non-STEMI [UA/NSTEMI]), of whom 10,613 (17.1%) had diabetes. A multivariable model was constructed to adjust for baseline characteristics, aspects of ACS presentation, and treatments for the ACS event. The study had as a main outcome measures the mortality at 30 days and 1 year following ACS among patients with diabetes vs patients without diabetes.
Results/Findings: Mortality at 30 days was significantly higher among patients with diabetes than without diabetes presenting with UA/NSTEMI (2.1% vs 1.1%, P< 0.001) and STEMI (8.5% vs 5.4%, P< 0.001). After adjusting for baseline characteristics and features and management of the ACS event, diabetes was independently associated with higher 30-day mortality after UA/NSTEMI (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.24-2.56) or STEMI (OR, 1.40; 95% CI, 1.24-1.57). Diabetes at presentation with ACS was associated with significantly higher mortality one year after UA/NSTEMI (hazard ratio [HR], 1.65; 95% CI, 1.30-2.10) or STEMI (HR, 1.22; 95% CI, 1.08-1.38). By one year following ACS, patients with diabetes presenting with UA/NSTEMI had a risk of death that approached patients without diabetes presenting with STEMI (7.2% vs 8.1%).
Comments: This study demonstrates a statistically robust association between diabetes at time of presentation with ACS and all-cause mortality at 30 days and at one year, even after adjusting for baseline characteristics as well as features and management of the index event. Despite advances in the treatment of ACS, the magnitude of excess mortality among patients with diabetes was considerable. The magnitude of risk conferred by diabetes following ACS demands a major research effort to reduce the influence of diabetes on coronary artery disease. Reducing coronary risk from diabetes requires a multi-factorial approach to manage all atherogenic influences. The authors of this article suggest a long-term, targeted, intensive use of proven therapies for the traditional coronary risk factors which should be widely promoted for patients with diabetes, particularly following ACS. Collaboration between medical societies, national health care organizations, and industry will be vital to halt the epidemic of diabetes-related cardiovascular disease.
Additional References:
1. Danaei G, Lawes CM, Vander Hoorn S, Murray CJ, Ezzati M. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk.
2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27(5): 1047-53.
Reply to this message
© 2013 ProCor | Privacy Policy