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

McGuire, D. K. (författare)
Newby, L. K. (författare)
Bhapkar, M. V. (författare)
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Moliterno, D. J. (författare)
Hochman, J. S. (författare)
Klein, W. W. (författare)
Weaver, W. D. (författare)
Pfisterer, M. (författare)
Corbalan, R. (författare)
Dellborg, Mikael, 1954 (författare)
Gothenburg University,Göteborgs universitet,Hjärt-kärlinstitutionen,Cardiovascular Institute
Granger, C. B. (författare)
Van de Werf, F. (författare)
Topol, E. J. (författare)
Califf, R. M. (författare)
visa färre...
 (creator_code:org_t)
2004
2004
Engelska.
Ingår i: Am Heart J. - 1097-6744. ; 147:2, s. 246-52
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
Stäng  
  • 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.

Nyckelord

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

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