Impact of Diabetes on Mortality After the First Myocardial Infarction

Miettinen, Heikki; Lehto, Seppo; Salomaa, Veikko; Mähönen, Markku; Niemelä, Matti; Haffner, Steven M.; Pyörälà, Kalevi; Tuomilehto, Jaakko

doi:10.2337/diacare.21.1.69

Cited by 581 publications

(296 citation statements)

References 35 publications

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“…This woman with diabetes, hypertension, LVH, and diabetic nephropathy has a risk for death from myocardial infarction (MI) or stroke that is at least as high as that for persons without diabetes who have already suffered from a MI or stroke [1][2][3][4] ( Figure 1). In addition, the case fatality rate after a MI among patients with diabetes is higher than that for patients without diabetes.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Cardiovascular and Renal Risk Factors in the Diabetic Hypertensive

Sowers

Haffner²

2002

Hypertension

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CaseA 38-year-old black woman is see 1 n on referral from a family physician. Her medical records indicate that she has had type 2 diabetes diagnosed 3 years previously. She has been treated for her diabetes with diet and a sulfonylurea, Glucotrol X-L 10 mg daily. Her last glycohemoglobin 6 months ago was 8.8%. She has had hypertension for Ϸ10 years and is currently receiving 10 mg amlodipine daily, 25 mg hydrochlorothiazide daily, and 4 mg doxazosin every morning. In her records, her physician notes that her blood pressure (BP) has been relatively well controlled, with BPs generally Ϸ150/90 mm Hg. She had an EKG 1 year previously, which was remarkable only for left ventricular hypertrophy (LVH) by voltage criteria. Her last total cholesterol was 230 mg/dL, with LDL cholesterol of 145 mg/dL. Her records indicated that she was not started on lipid therapy because her LDL was Ͻ150 mg/dL. She has a strong family history of diabetes, hypertension, coronary artery disease, stroke, and kidney disease requiring dialysis. Physical ExaminationThe patient's BP was 154/92 mm Hg, with a pulse of 88 bpm. Her weight was 190 lbs (body mass index, 35 kg/m 2 ). Examination of the head, ears, eyes, nose and throat (HEENT) revealed fundi with background retinopathy (hemorrhages and exudates). Examination of the heart showed that the point of maximum impulse (PMI) was shifted to the anterior auxiliary line and sustained, with an S 4 gallop present. Examination of the patient's abdomen revealed a waist circumference of 38 inches, a slightly enlarged liver, and no abdominal bruits. Examination of the patient's lower extremities showed that the dorsalis pedis and posterior tibial pulses were noticeably decreased in amplitude, and 2ϩ pretibial pitting edema was present. Laboratory ValuesLaboratory values were as follows: fasting glucose, 140 mg/dL; glycosylated hemoglobin [HbA1c], 8.5%; creatinine, 2.0 mg/dL; urinary albumin, 0.8 mg/dL; total cholesterol, 250 mg/dL (HDL cholesterol, 35 mg/dL; LDL cholesterol, 165 mg/dL; and triglycerides [TGs], 250 mg/dL), and electrolytes serum potassium, 4.7 mmol/L. The EGK showed LVH by voltage criteria.

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Section: Discussionmentioning

confidence: 99%

Treatment of Cardiovascular and Renal Risk Factors in the Diabetic Hypertensive

Sowers

Haffner²

2002

Hypertension

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“…The reason for this fundamental step was the undisputed evidence that Type 2 diabetic subjects without a prior history of myocardial infarction (MI) have as a high risk of CHD as non-diabetic patients who have had a previous MI [4,5] as well as the extremely poor short-term prognosis of Type 2 diabetic subjects after their first MI [154,155]. ATP III and ADA guidelines identified LDL cholesterol as the first priority of lipid lowering and the optimal level was set <2.6 mmol/l [6,156].…”

Section: Consequences Of the Increase Of Vldl 1 Particlesmentioning

confidence: 99%

Diabetic dyslipidaemia: from basic research to clinical practice*

2003

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The recognition that the increase of plasma triglyceride rich lipoproteins (TRLs) is associated with multiple alterations of other lipoproteins species that are potentially atherogenic has expanded the picture of diabetic dyslipidaemia. The discovery of heterogeneity within major lipoprotein classes VLDL, LDL and HDL opened new avenues to reveal the specific pertubations of diabetic dyslipidaemia. The increase of large VLDL 1 particles in Type 2 diabetes initiates a sequence of events that generates atherogenic remnants, small dense LDL and small dense HDL particles. Together these components comprise the atherogenic lipid triad. Notably the malignant nature of diabetic dyslipidaemia is not completely shown by the lipid measures used in clinical practice. The key question is what are the mechanisms behind the increase of VLDL 1 particles in diabetic dyslipidaemia? Despite the advances of recent years, our understanding of VLDL assembly and secretion is still surprisingly incomplete. To date it is still unclear how the liver is able to regulate the amount of triglycerides incorporated into VLDL particles to produce either VLDL 1 or VLDL 2 particles. The current evidence suggests that the machinery driving VLDL assembly in the liver includes (i) low insulin signalling via PI-3 kinase pathway that enhances lipid accumulation into "nascent" VLDL particles (ii) up-regulation of SREBP-1C that stimulates de novo lipogenesis and (iii) excess availability of "polar molecules" in hepatocytes that stabilizes apo B 100. Recent data suggest that all these steps could be fundamentally altered in Type 2 diabetes explaining the overproduction of VLDL apo B as well as the ability of insulin to suppress VLDL 1 apo B production in Type 2 diabetes.Recent discoveries have established the transcription factors including PPARs, SREBP-1 and LXRs as the key regulators of lipid assembly in the liver. These observations suggest these factors as a new target to tailor more efficient drugs to treat diabetic dyslipidaemia. [Diabetologia (2003) 46:733-749]

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“…Therefore, prevention of CHD is essential for this population 1, 3, 5, 6. Major risk factors including dyslipidemia are common among individuals with diabetes mellitus 7.…”

Section: Introductionmentioning

confidence: 99%

Race‐Sex Differences in Statin Use and Low‐Density Lipoprotein Cholesterol Control Among People With Diabetes Mellitus in the Reasons for Geographic and Racial Differences in Stroke Study

Gamboa

Colantonio

Brown

et al. 2017

JAHA

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BackgroundStatin therapy is a cornerstone of cardiovascular disease risk reduction for people with diabetes mellitus. Past reports have shown race‐sex differences in statin use in general populations, but statin patterns by race and sex in those with diabetes mellitus have not been thoroughly studied.Methods and ResultsOur sample of 4288 adults ≥45 years of age with diagnosed diabetes mellitus who had low‐density lipoprotein cholesterol (LDL‐C) >100 mg/dL or were taking statins recruited for the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2007. Exposures included race‐sex groups (white men [WM], black men [BM], white women [WW], black women [BW]) and factors that may influence healthcare utilization. Proportions and prevalence ratios were calculated for statin use and LDL‐C control. Statin use for WM, BM, WW, and BW was 66.0%, 57.8%, 55.0%, and 53.6%, respectively (P<0.001). After adjustment for healthcare utilization factors, statin use was lower for BM, WW, and BW compared with WM (prevalence ratios [95%CI]: 0.96 [0.89‐1.03], 0.86 [0.80‐0.92], and 0.87 [0.81‐0.93], respectively, P<0.001). LDL‐C control among those taking statins for WM, BM, WW, and BW was 75.3%, 62.7%, 69.0%, and 56.0%, respectively (P<0.001). After adjustment, LDL‐C control was lower for BM, WW, and BW compared with WM (prevalence ratios [95%CI]: 0.85 [0.79‐0.93], 0.89 [0.82‐0.96], and 0.73 [0.67‐0.80], respectively, P<0.001).ConclusionsRace‐sex disparities in statin use and LDL‐C control were only partly explained by factors influencing health services utilization. Healthcare provider awareness of these disparities may help to close the observed race‐sex gaps in statin use and LDL‐C control among people with diabetes mellitus.

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Impact of Diabetes on Mortality After the First Myocardial Infarction

Abstract: The high mortality rate of diabetic patients after their first myocardial infarction and the high proportion of out-of-hospital deaths in this group imply that vigorous primary and secondary preventive measures should become an integral part of their medical care.

Cited by 581 publications

References 35 publications

Treatment of Cardiovascular and Renal Risk Factors in the Diabetic Hypertensive

Treatment of Cardiovascular and Renal Risk Factors in the Diabetic Hypertensive

Diabetic dyslipidaemia: from basic research to clinical practice*

Race‐Sex Differences in Statin Use and Low‐Density Lipoprotein Cholesterol Control Among People With Diabetes Mellitus in the Reasons for Geographic and Racial Differences in Stroke Study

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