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New Diabetes Linked with Poor Outcomes After MI

Findings support screening for new diabetes after myocardial infarction.

Patients with previously known diabetes are at risk for poor outcomes after myocardial infarction. But what happens when diabetes is newly diagnosed at the time of the MI? To find out, researchers studied data from a randomized controlled trial of angiotensin-receptor-blocker therapy for acute MI that involved 14,703 patients: 23% with previously known diabetes, 4% with newly diagnosed diabetes, and 73% without diabetes.

Compared with patients who had known diabetes, newly diagnosed patients were slightly younger (63.9 vs. 66.5 years) and had fewer comorbid conditions such as prior MI (22% vs. 35%) or heart failure (10% vs. 23%). However, compared with nondiabetics, the two diabetic groups had similar multivariable-adjusted hazard ratios for death (about 1.4-1.5) and for cardiovascular events (about 1.3-1.4) at 1 year after enrollment.

Comment: These data suggest that diabetes-related metabolic factors contribute to poor outcomes after MI, regardless of how recently diabetes was diagnosed. The results are also consistent with the idea that vascular abnormalities and end-organ damage could occur well before formal diagnosis. Although new diabetes diagnoses in this study were based on local physician evaluation rather than on a uniform blood-glucose cutoff, the data support screening for new diabetes in MI patients so that this high-risk group can be identified and treated accordingly.

— Kirsten E. Fleischmann, MD, MPH

Published in Journal Watch General Medicine October 22, 2004

Citation(s):

Aguilar D et al. Newly diagnosed and previously known diabetes mellitus and 1-year outcomes of acute myocardial infarction: The VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Circulation 2004 Sep 21; 110:1572-8.

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