Association of diabetes mellitus and glycemic control strategies with clinical outcomes after acute coronary syndromes - 26/08/11
, L.Kristin Newby, MD b, Manjushri V Bhapkar, MS b, David J Moliterno, MD c, Judith S Hochman, MD d, Werner W Klein, MD e, W.Douglas Weaver, MD f, Matthias Pfisterer, MD g, Ramón Corbalán, MD h, Mikael Dellborg, MD i, Christopher B Granger, MD b, Frans Van De Werf, MD j, Eric J Topol, MD c, Robert M Califf, MD bSYMPHONY and 2nd SYMPHONY Investigators
Abstract |
Background |
Diabetes is associated with an increased risk for coronary artery disease (CAD) and its complications. The relative effect of glucose-lowering strategies of “insulin provision” versus “insulin sensitization” among patients with CAD remains unclear.
Methods |
To evaluate the associations of diabetes and hypoglycemic strategies with clinical outcomes after acute coronary syndromes, we analyzed data from 15,800 patients enrolled in the SYMPHONY and 2nd SYMPHONY trials.
Results |
Compared with nondiabetic patients, patients with diabetes (n = 3101; 19.6%) were older, more often female, more often had prior CAD, hypertension, and hyperlipidemia, and less often were current smokers. The diabetic cohort had higher 90-day unadjusted risk of the composite of death/myocardial infarction (MI)/severe recurrent ischemia (SRI), death/MI, and death alone, as well as a near doubling of 1-year mortality rates. At 1 year, diabetes was associated with significantly higher adjusted risks of death/MI/SRI (OR, 1.3 [95% confidence interval, 1.1, 1.5]) and death/MI (OR, 1.2 [1.0, 1.4]). Hypoglycemic therapy including only insulin and/or sulfonylurea (insulin-providing; n = 1473) was associated with higher 90-day death/MI/SRI compared with therapy that included only biguanide and/or thiazolidinedione therapy (insulin-sensitizing; n = 100) (12.0% vs 5.0%); (adjusted OR, 2.1 [1.2, 3.7]).
Conclusions |
Diabetic patients with acute coronary syndromes had worse clinical outcomes. Although the findings regarding the influence of glycemic-control strategies should be interpreted with caution because of the exploratory nature of the analyses and the relatively small sample size of the insulin-sensitizing group, the improved risk-adjusted outcomes associated with insulin-sensitizing therapy underscore the need to further evaluate treatment strategies for patients with diabetes and CAD.
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 | The SYMPHONY and 2nd SYMPHONY trials were supported by a grant from F. Hoffmann-La Roche, Ltd, Basel, Switzerland. Guest Editor for this manuscript was W. Douglas Weaver, MD, Henry Ford Heart and Vascular Institute, Detroit, Mich. |
Vol 147 - N° 2
P. 246-252 - février 2004 Retour au numéro
Article précédent
- High fasting glucose levels as a predictor of worse clinical outcome in patients with coronary artery disease: results from the Bezafibrate Infarction Prevention (BIP) study
- Lidia Arcavi, Solomon Behar, Avraham Caspi, Naama Reshef, Valentina Boyko, Hilla Knobler
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- Rajendra H Mehta, Immad Sadiq, Robert J Goldberg, Joel M Gore, Álvaro Avezum, Frederick Spencer, Eva Kline-Rogers, Jeanna Allegrone, Karen Pieper, Keith A.A Fox, Kim A Eagle, GRACE Investigators
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