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Patients with diabetes have increased 30-day and 1-year mortality following acute coronary syndromes, compared with patients without diabetes, according to an analysis of more than 60,000 patients.
At 30 days after acute coronary syndrome (ACS), diabetes was a significant independent factor associated with all-cause mortality for patients presenting with ST-segment elevation myocardial infarction (STEMI) and for those with unstable angina/non-STEMI (UA/NSTEMI), with adjusted odds ratios of 1.40 and 1.78, respectively. At 12 months, diabetes remained a significant independent predictor of mortality for both patient groups, with adjusted hazard ratios of 1.22 and 1.65, respectively.
The data were adjusted for baseline characteristics, as well as features and management of the index ACS event.
Also at 12 months, “patients with diabetes and presenting with UA/NSTEMI had a mortality that approached patients without diabetes and presenting with STEMI (7.2% vs. 8.1%),” the researchers reported (JAMA 2007;298:765–75).
The analysis pooled 62,036 ACS patients from 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials. A total of 46,577 patients presented with STEMI, and the remaining 15,459 patients presented with UA/NSTEMI. A total of 10,613 patients had diabetes by self-report, wrote lead author Dr. Sean M. Donahoe of Cornell University Medical Center, New York, and colleagues.
“The burden of cardiovascular risk inherent among the patients presenting with UA/NSTEMI marked the index ACS presentation as a sentinel event in a chronic, progressive course that was more accelerated among patients with diabetes,” they wrote. “The UA/NSTEMI population is enriched with this high-risk diabetic population.”
Several limitations to the study were noted by the authors, including the possibility of intertrial variability in ACS management, and the self-reporting of diabetes status.
Noting “the increasing burden of cardiovascular disease attributable to diabetes worldwide,” the authors pointed to “the need for a major research effort to identify aggressive new strategies to manage unstable ischemic heart disease among this high-risk population.” They recommended that “long-term, targeted, intensive use of proven therapies for the traditional coronary risk factors must be widely promoted for patients with diabetes, particularly following ACS,” suggesting that, “more stringent targets for patients with diabetes may be better all around.
“Collaboration between medical societies, national health care organizations, and industry will be vital to halt the epidemic of diabetes-related cardiovascular disease,” they concluded.
Patients with diabetes have increased 30-day and 1-year mortality following acute coronary syndromes, compared with patients without diabetes, according to an analysis of more than 60,000 patients.
At 30 days after acute coronary syndrome (ACS), diabetes was a significant independent factor associated with all-cause mortality for patients presenting with ST-segment elevation myocardial infarction (STEMI) and for those with unstable angina/non-STEMI (UA/NSTEMI), with adjusted odds ratios of 1.40 and 1.78, respectively. At 12 months, diabetes remained a significant independent predictor of mortality for both patient groups, with adjusted hazard ratios of 1.22 and 1.65, respectively.
The data were adjusted for baseline characteristics, as well as features and management of the index ACS event.
Also at 12 months, “patients with diabetes and presenting with UA/NSTEMI had a mortality that approached patients without diabetes and presenting with STEMI (7.2% vs. 8.1%),” the researchers reported (JAMA 2007;298:765–75).
The analysis pooled 62,036 ACS patients from 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials. A total of 46,577 patients presented with STEMI, and the remaining 15,459 patients presented with UA/NSTEMI. A total of 10,613 patients had diabetes by self-report, wrote lead author Dr. Sean M. Donahoe of Cornell University Medical Center, New York, and colleagues.
“The burden of cardiovascular risk inherent among the patients presenting with UA/NSTEMI marked the index ACS presentation as a sentinel event in a chronic, progressive course that was more accelerated among patients with diabetes,” they wrote. “The UA/NSTEMI population is enriched with this high-risk diabetic population.”
Several limitations to the study were noted by the authors, including the possibility of intertrial variability in ACS management, and the self-reporting of diabetes status.
Noting “the increasing burden of cardiovascular disease attributable to diabetes worldwide,” the authors pointed to “the need for a major research effort to identify aggressive new strategies to manage unstable ischemic heart disease among this high-risk population.” They recommended that “long-term, targeted, intensive use of proven therapies for the traditional coronary risk factors must be widely promoted for patients with diabetes, particularly following ACS,” suggesting that, “more stringent targets for patients with diabetes may be better all around.
“Collaboration between medical societies, national health care organizations, and industry will be vital to halt the epidemic of diabetes-related cardiovascular disease,” they concluded.
Patients with diabetes have increased 30-day and 1-year mortality following acute coronary syndromes, compared with patients without diabetes, according to an analysis of more than 60,000 patients.
At 30 days after acute coronary syndrome (ACS), diabetes was a significant independent factor associated with all-cause mortality for patients presenting with ST-segment elevation myocardial infarction (STEMI) and for those with unstable angina/non-STEMI (UA/NSTEMI), with adjusted odds ratios of 1.40 and 1.78, respectively. At 12 months, diabetes remained a significant independent predictor of mortality for both patient groups, with adjusted hazard ratios of 1.22 and 1.65, respectively.
The data were adjusted for baseline characteristics, as well as features and management of the index ACS event.
Also at 12 months, “patients with diabetes and presenting with UA/NSTEMI had a mortality that approached patients without diabetes and presenting with STEMI (7.2% vs. 8.1%),” the researchers reported (JAMA 2007;298:765–75).
The analysis pooled 62,036 ACS patients from 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials. A total of 46,577 patients presented with STEMI, and the remaining 15,459 patients presented with UA/NSTEMI. A total of 10,613 patients had diabetes by self-report, wrote lead author Dr. Sean M. Donahoe of Cornell University Medical Center, New York, and colleagues.
“The burden of cardiovascular risk inherent among the patients presenting with UA/NSTEMI marked the index ACS presentation as a sentinel event in a chronic, progressive course that was more accelerated among patients with diabetes,” they wrote. “The UA/NSTEMI population is enriched with this high-risk diabetic population.”
Several limitations to the study were noted by the authors, including the possibility of intertrial variability in ACS management, and the self-reporting of diabetes status.
Noting “the increasing burden of cardiovascular disease attributable to diabetes worldwide,” the authors pointed to “the need for a major research effort to identify aggressive new strategies to manage unstable ischemic heart disease among this high-risk population.” They recommended that “long-term, targeted, intensive use of proven therapies for the traditional coronary risk factors must be widely promoted for patients with diabetes, particularly following ACS,” suggesting that, “more stringent targets for patients with diabetes may be better all around.
“Collaboration between medical societies, national health care organizations, and industry will be vital to halt the epidemic of diabetes-related cardiovascular disease,” they concluded.