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Association of diab...
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McGuire, D. K.
(författare)
Association of diabetes mellitus and glycemic control strategies with clinical outcomes after acute coronary syndromes
- Artikel/kapitelEngelska2004
Förlag, utgivningsår, omfång ...
Nummerbeteckningar
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LIBRIS-ID:oai:gup.ub.gu.se/56557
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https://gup.ub.gu.se/publication/56557URI
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Ämneskategori:ref swepub-contenttype
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Ämneskategori:art swepub-publicationtype
Anmärkningar
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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.
Ämnesord och genrebeteckningar
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Aged
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Angina
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Unstable/complications
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*Diabetes Complications
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Diabetes Mellitus/*drug therapy
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Female
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Humans
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Hypertension/complications
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Hypoglycemic Agents/*therapeutic use
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Male
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Middle Aged
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Multivariate Analysis
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Myocardial Infarction/etiology/prevention & control
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Myocardial Ischemia/*complications/mortality
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Prognosis
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Recurrence/prevention & control
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Risk Factors
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Smoking
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Treatment Outcome
Biuppslag (personer, institutioner, konferenser, titlar ...)
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Newby, L. K.
(författare)
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Bhapkar, M. V.
(författare)
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Moliterno, D. J.
(författare)
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Hochman, J. S.
(författare)
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Klein, W. W.
(författare)
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Weaver, W. D.
(författare)
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Pfisterer, M.
(författare)
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Corbalan, R.
(författare)
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Dellborg, Mikael,1954Gothenburg University,Göteborgs universitet,Hjärt-kärlinstitutionen,Cardiovascular Institute(Swepub:gu)xdelmi
(författare)
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Granger, C. B.
(författare)
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Van de Werf, F.
(författare)
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Topol, E. J.
(författare)
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Califf, R. M.
(författare)
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Göteborgs universitetHjärt-kärlinstitutionen
(creator_code:org_t)
Sammanhörande titlar
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Ingår i:Am Heart J147:2, s. 246-521097-6744
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Till lärosätets databas
- Av författaren/redakt...
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McGuire, D. K.
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Newby, L. K.
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Bhapkar, M. V.
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Moliterno, D. J.
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Hochman, J. S.
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Klein, W. W.
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visa fler...
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Weaver, W. D.
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Pfisterer, M.
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Corbalan, R.
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Dellborg, Mikael ...
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Granger, C. B.
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Van de Werf, F.
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Topol, E. J.
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Califf, R. M.
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visa färre...
- Artiklar i publikationen
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Am Heart J
- Av lärosätet
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Göteborgs universitet