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  • McGuire, D. K. (author)

Association of diabetes mellitus and glycemic control strategies with clinical outcomes after acute coronary syndromes

  • Article/chapterEnglish2004

Publisher, publication year, extent ...

  • 2004

Numbers

  • LIBRIS-ID:oai:gup.ub.gu.se/56557
  • https://gup.ub.gu.se/publication/56557URI

Supplementary language notes

  • Language:English

Part of subdatabase

Classification

  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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.

Subject headings and genre

  • Aged
  • Angina
  • Unstable/complications
  • *Diabetes Complications
  • Diabetes Mellitus/*drug therapy
  • Female
  • Humans
  • Hypertension/complications
  • Hypoglycemic Agents/*therapeutic use
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction/etiology/prevention & control
  • Myocardial Ischemia/*complications/mortality
  • Prognosis
  • Recurrence/prevention & control
  • Risk Factors
  • Smoking
  • Treatment Outcome

Added entries (persons, corporate bodies, meetings, titles ...)

  • Newby, L. K. (author)
  • Bhapkar, M. V. (author)
  • Moliterno, D. J. (author)
  • Hochman, J. S. (author)
  • Klein, W. W. (author)
  • Weaver, W. D. (author)
  • Pfisterer, M. (author)
  • Corbalan, R. (author)
  • Dellborg, Mikael,1954Gothenburg University,Göteborgs universitet,Hjärt-kärlinstitutionen,Cardiovascular Institute(Swepub:gu)xdelmi (author)
  • Granger, C. B. (author)
  • Van de Werf, F. (author)
  • Topol, E. J. (author)
  • Califf, R. M. (author)
  • Göteborgs universitetHjärt-kärlinstitutionen (creator_code:org_t)

Related titles

  • In:Am Heart J147:2, s. 246-521097-6744

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