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Göteborgs universitets publikationer

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

Författare och institution:
D. K. McGuire (-); L. K. Newby (-); M. V. Bhapkar (-); D. J. Moliterno (-); J. S. Hochman (-); W. W. Klein (-); W. D. Weaver (-); M. Pfisterer (-); R. Corbalan (-); Mikael Dellborg (Hjärt-kärlinstitutionen); C. B. Granger (-); F. Van de Werf (-); E. J. Topol (-); R. M. Califf (-)
Publicerad i:
Am Heart J, 147 ( 2 ) s. 246-52
1097-6744 (Electronic)
Artikel, refereegranskad vetenskaplig
Sammanfattning (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.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
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
Postens nummer:
Posten skapad:
2007-10-23 13:37

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