Myocardial Infarction Site and Mortality in Diabetes

Weitzman, S; Wagner, Galen S.; Heiss, Gerardo; Haney, Thomas L.; Slome, Cecil

doi:10.2337/diacare.5.1.31

Cited by 34 publications

(10 citation statements)

References 5 publications

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“…The lack of effect of duration is well recognized (14,24,30,43). However, several previous reports have found that the excess case fatality is more marked in women (11,13,30,32,43,44), and the Framingham study described a more marked excess of cardiovascular mortality, but not incidence, in women than in men (1). We found no relation between premorbid blood glucose control and hospital outcome.…”

Section: Discussionmentioning

confidence: 93%

Determinants of Hospital Admission and Case Fatality in Diabetic Patients With Myocardial Infarction

Yudkin

Oswald²

1988

Diabetes Care

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We compare the clinical features and hospital outcomes in 83 diabetic patients admitted with acute myocardial infarction and 380 nondiabetic patients with levels of glycosylated hemoglobin (HbA1c) low enough to exclude undiagnosed diabetes. The hospital mortality was 42.2% in diabetic and 24.7% in nondiabetic patients, an odds ratio of 2.22 (CI 1.37-3.60, P less than .002). The excess mortality was due to cardiogenic shock and left ventricular failure (pump failure). There was no difference in peak levels of aspartate transaminase between the groups. Among the diabetic patients, the admission levels of plasma glucose and peak levels of aspartate transaminase were higher among those who developed pump failure or died, but there was no relationship between outcome and gender, disease duration, or treatment. Prior blood glucose control, as judged by levels of HbA1c, was not related to hospital outcome (P greater than .5). In a further study, the 83 diabetic patients were compared with 249 age- and sex-matched diabetic subjects without myocardial infarction for treatment, disease duration, and control. There was an increased risk of admission with myocardial infarction of 2.35 (CI 1.41-3.92, P less than .005) within the first 5 yr of diagnosis of diabetes. Infarct patients had significantly lower levels of HbA1c than control subjects (P less than .005), but treatment did not differ between groups. Neither incidence nor case fatality of myocardial infarction in diabetic patients is positively associated with cumulative glycemic exposure.

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Section: Discussionmentioning

confidence: 93%

Determinants of Hospital Admission and Case Fatality in Diabetic Patients With Myocardial Infarction

Yudkin

Oswald²

1988

Diabetes Care

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“…Other data [32] from a study involving 54 subjects and 270 normoglycaemic controls, also showed that anterior infarcts were more common (43% vs 13%) and had a significant adverse impact, the 60 day mortality being 55% in diabetic vs 31% in nondiabetic subjects. Other complications which appear more common are anterior wall rupture which is 2·7 times more likely and cardiogenic shock.…”

Section: Infarction Sitementioning

confidence: 89%

The clinical implications of diabetic heart disease

Butler

MacDonald

Struthers

et al. 1998

European Heart Journal

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“…While Barrett-Connor, utilizing data from the Rancho Bernardo study, has focussed attention on the IHD mortality protection experienced by nondiabetic women (7), a number of other studies have suggested that diabetic women have a greater case fatality following a myocardial infarction than either men with diabetes or when compared to either gender without diabetes (39)(40)(41)(42)(43). This, however, is not a universal finding (44)(45)(46). It appears that the greatest increased case fatality occurs in women in the short term (30-60 days) rather than over the long term (41).…”

Section: Why Does Diabetes Cause a Greater Impact Onmentioning

confidence: 90%

The Impact of Gender and General Risk Factors on the Occurrence of Atherosclerotic Vascular Disease in Non-insulin-dependent Diabetes Mellitus

Orchard

1996

Annals of Medicine

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While it is generally accepted that non-insulin-dependent diabetes mellitus (NIDDM) increases atherosclerotic risk, controversy remains as to whether this effect is greater for women than men (thus reducing the usual gender differential). Furthermore, it is unclear to what extent changes in general risk factors may account for this increased risk. The literature was reviewed with meta-analyses. Gender specific overall relative risks with 95% confidence intervals for coronary heart disease (CHD) mortality (ICD codes 410-414) were calculated. Similarly, overall gender specific odds ratios for prevalent myocardial infarction (MI) are presented. Data are generated from both fixed effects and random effects models. Frequency counts of studies showing specific cardiovascular disease (CVD) risk factor effects in diabetes are given as is the number of studies showing diabetes to be an independent risk factor. The overall relative risk (the ratio of men to women) for CHD mortality in diabetes was 1.46 (1.21-1.75) and 2.29 (2.05-2.55) in nondiabetes suggesting that the gender differential is reduced in diabetes. However, heterogeneity was high (P < 0.001). Exclusion of studies that were exclusively in elderly subjects eliminated heterogeneity (P > 0.05), but retained a separation of the confidence intervals. Overall odds ratios (men:women) show no suggestion of a diabetes effect on the gender difference for prevalent MI, 1.77 (diabetes) and 1.79 (no diabetes). The effects of six general CVD risk factors were unclear, although the largest study showed a clear effect of cholesterol, smoking, and blood pressure. All 10 studies in women report diabetes to be an independent risk factor as do 8 out of 12 studies in men. NIDDM reduces the gender differential in CHD mortality, but not for prevalent MI (or other end points). Although the effect of specific CVD risk factors is inconsistent across studies, this is likely to reflect limited sample size and power. The major three risk factors, cholesterol, blood pressure, and smoking, probably operate in NIDDM but do not fully explain the increased risk of CVD in NIDDM.

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Myocardial Infarction Site and Mortality in Diabetes

Cited by 34 publications

References 5 publications

Determinants of Hospital Admission and Case Fatality in Diabetic Patients With Myocardial Infarction

Determinants of Hospital Admission and Case Fatality in Diabetic Patients With Myocardial Infarction

The clinical implications of diabetic heart disease

The Impact of Gender and General Risk Factors on the Occurrence of Atherosclerotic Vascular Disease in Non-insulin-dependent Diabetes Mellitus

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