A history of diabetes predicts outcomes following myocardial infarction: an analysis of the 28 771 patients in the High‐Risk <scp>MI</scp> Database

Tajik, Athar Ali; Dobre, Daniela; Aguilar, David; Kjekshus, John; Zannad, Faı̈ez; Dickstein, Kenneth

doi:10.1002/ejhf.797

Cited by 30 publications

(32 citation statements)

References 39 publications

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“…With the rising prevalence of CMS and from a population health perspective, it is continuously becoming more important to focus on metabolic syndrome. From a cardiovascular‐specific viewpoint, two main reasons prompt our interest; the first is that metabolic syndrome directly correlates with the development of atherosclerotic cardiovascular disease (CVD) in addition to many chronic diseases 1,2 and has also been shown to lead to worse outcomes in patients who suffer consequences from various CVD processes 3 . CMS was associated with two‐ to fourfold increase in the risk of CVD, CVD mortality, and stroke, and a 1.5‐fold increase in risk of all‐cause mortality 4,5 .…”

Section: Introductionmentioning

confidence: 99%

“…Myocardial infarction (MI) and stroke were twice more likely to be prevalent in patients with CMS in both genders 6 with 1.78 relative risks for CVD events and death related to CMS 7 . And in patients who suffered MI from CVD, the postincident outcome was much worse in the presence of diabetes; in patients with diabetes, there was a significantly higher rate of all‐cause mortality, mortality related to CVD (sudden death, reinfarction, stroke, and worsening heart failure), and all‐cause and cardiovascular‐specific hospitalizations, including significantly higher readmission for heart failure, recurrent MI, and new stroke 3 . The second main reason to focus on metabolic syndrome today is because of its rising prevalence.…”

Section: Introductionmentioning

confidence: 99%

“…7 And in patients who suffered MI from CVD, the postincident outcome was much worse in the presence of diabetes; in patients with diabetes, there was a significantly higher rate of all-cause mortality, mortality related to CVD (sudden death, reinfarction, stroke, and worsening heart failure), and all-cause and cardiovascular-specific hospitalizations, including significantly higher readmission for heart failure, recurrent MI, and new stroke. 3 The second main reason to focus on metabolic syndrome today is because of its rising prevalence. In 2004 one study predicted that the total number of people with diabetes in the world would rise from 171 to 366 million between 2000 and 2030.…”

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Effects and outcomes of cardiac surgery in patients with cardiometabolic syndrome

et al. 2020

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Introduction Cardiometabolic syndrome (CMS) is diabetes mellitus (or insulin resistance) plus any two of the following risk factors: hypertension, obesity, and hyperlipidemia. The correlation of metabolic syndrome with cardiovascular disease and the increase in the prevalence of patients with risk factors have solidified the importance of continued focus on metabolic syndrome. We retrospectively evaluated single‐center data to determine if there is an association between CMS and outcomes. Methods The local Society of Thoracic Surgeons Adult Cardiac Database was queried for consecutive coronary bypass (CABG) cases from 2002 to 2010. Short and long‐term outcomes were compared between groups of patients with CMS and then risk‐adjusted using multiple regression models with adjusted odds ratios and hazard ratios. Results Of 11 021 CABG cases, 3881 (35.2%) had CMS, with an annual prevalence that increased from 32% to 40% during the study. Patients with CMS were more likely to have prior cerebrovascular diseases, strokes, renal insufficiency, and worse New York Heart Association status. Unadjusted postoperative comparisons revealed that patients with CMS had higher rates of stroke, renal failure, dialysis, deep sternal wound infection, and longer intensive care unit and hospital length of stay. Risk‐adjusted odds ratios did not reveal a significant impact on short‐term outcomes, however, adjusted hazard ratios continued to demonstrate significant decreases in long‐term survival in patients with CMS. Conclusions Patients with CMS were more likely to present with increased comorbidities. Patients with CMS undergoing CABG were at risk for worse short‐term secondary postoperative outcomes and reduced long‐term survival. The data supports the need for further investigation for risk reduction surrounding operative revascularization.

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confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects and outcomes of cardiac surgery in patients with cardiometabolic syndrome

et al. 2020

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“…Diabetes and impaired kidney function, two of the most common co‐morbidities among patients with MI, are associated with high rates of cardiovascular and all‐cause death. There is substantial evidence indicating the association between diabetes and SCD in patients with atherosclerotic coronary artery disease or following MI, although little is known regarding its interplay with impaired kidney function, a common condition in diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

Association of diabetes and kidney function according to age and systolic function with the incidence of sudden cardiac death and non‐sudden cardiac death in myocardial infarction survivors with heart failure

Coiro

Girerd

Sharma

et al. 2019

European J of Heart Fail

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Aims An implantable cardioverter‐defibrillator (ICD) is recommended for reducing the risk of sudden cardiac death (SCD) in myocardial infarction (MI) patients with a left ventricular ejection fraction (LVEF) ≤ 30%, as well as patients with a LVEF ≤ 35% and heart failure symptoms. Diabetes and/or impaired kidney function may confer additional SCD risk. We assessed the association between these two risk factors with SCD and non‐SCD among MI survivors taking account of age and LVEF. Methods and results A total of 17 773 patients from the High‐Risk MI Database were evaluated. Overall, diabetes and estimated glomerular filtration rate < 60 mL/min/1.73 m2, individually and together, conferred a higher risk of SCD [adjusted competing risk: hazard ratio (HR) 1.23, 1.23, and 1.32, respectively; all P < 0.03] and non‐SCD (HR 1.34, 1.52, and 2.13, respectively; all P < 0.0001). Annual SCD rates in patients with LVEF > 35% and with diabetes, impaired kidney function, or both (2.0%, 2.5% and 2.7%, respectively) were comparable to rates observed in patients with LVEF 30–35% but no such risk factors (1.7%). However, these patients had also similarly higher non‐SCD rates, such that the ratio of SCD to non‐SCD was not increased. Importantly, this ratio was mostly dependent on age, with higher overall ratios in youngest subgroups (0.89 in patients < 55 years vs. 0.38 in patients ≥ 75 years), regardless of risk factors. Conclusion Although MI survivors with LVEF > 35% with diabetes, impaired kidney function, or both are at increased risk of SCD, the risk of non‐SCD risk is even higher, suggesting an extension of the current indication for an ICD to them is unlikely to be worthwhile. MI survivors with low LVEF and aged < 55 years are likely to have the greatest potential benefit from ICD implantation.

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“…Although recent studies show that adult human cardiomyocytes have a turnover rate , it is limited and insufficient for restoration of contractile dysfunction during heart failure. Given the adverse structural and functional changes in the diabetic heart , there remains a higher risk of developing heart failure in patients with diabetes .…”

Section: Introductionmentioning

confidence: 99%

Concise Review: Challenges in Regenerating the Diabetic Heart: A Comprehensive Review

2017

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Stem cell therapy is one of the promising regenerative strategies developed to improve cardiac function in patients with ischemic heart diseases (IHD). However, this approach is limited in IHD patients with diabetes due to a progressive decline in the regenerative capacity of stem cells. This decline is mainly attributed to the metabolic memory incurred by diabetes on stem cell niche and their systemic cues. Understanding the molecular pathways involved in the diabetes-induced deterioration of stem cell function will be critical for developing new cardiac regeneration therapies. In this review, we first discuss the most common molecular alterations occurring in the diabetic stem cells/progenitor cells. Next, we highlight the key signaling pathways that can be dysregulated in a diabetic environment and impair the mobilization of stem/progenitor cells, which is essential for the transplanted/endogenous stem cells to reach the site of injury. We further discuss the possible methods of preconditioning the diabetic cardiac progenitor cell (CPC) with an aim to enrich the availability of efficient stem cells to regenerate the diseased diabetic heart. Finally, we propose new modalities for enriching the diabetic CPC through genetic or tissue engineering that would aid in developing autologous therapeutic strategies, improving the proliferative, angiogenic, and cardiogenic properties of diabetic stem/progenitor cells. STEM CELLS 2017;35:2009-2026 SIGNIFICANCE STATEMENTStem cell therapy is gaining global interest as the next generation of drug treatment in patients with ischemic heart disease. However, this approach is limited in patients with diabetes, due to the reduction in the available pool and functional deficit of the diabetic stem/progenitor cells. To our knowledge, this is the first review summarizing the molecular alterations in the diabetic cardiac progenitor/stem cells, which reduce its functional efficacy. We believe this review will provide a strong foundation for several future studies aiming to regenerate the diabetic heart by restoring the dysregulated molecular signaling cascade in the diabetic stem/progenitor cells.

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A history of diabetes predicts outcomes following myocardial infarction: an analysis of the 28 771 patients in the High‐Risk MI Database

Abstract: The risk for adverse outcomes associated with diabetes remains elevated even after debut of coronary artery disease in patients with MI complicated by clinical signs of HF or LVD. This association is particularly strong for HF-related outcomes.

Cited by 30 publications

References 39 publications

Effects and outcomes of cardiac surgery in patients with cardiometabolic syndrome

Effects and outcomes of cardiac surgery in patients with cardiometabolic syndrome

Association of diabetes and kidney function according to age and systolic function with the incidence of sudden cardiac death and non‐sudden cardiac death in myocardial infarction survivors with heart failure

Concise Review: Challenges in Regenerating the Diabetic Heart: A Comprehensive Review

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