Myocardial infarction in the diabetic patient

Abstract

Summary: It has long been thought that the symptomatology and prognosis of coronary events in patients with diabetes may differ from those in nondiabetic persons. A review of recent data demonstrates a higher mortality during the acute phase of myocardial infarction for diabetic patients than for their nondiabetic counterparts, possibIy related to a higher incidence of congestive heart failure and cardiogenic shock. The clinical course of diabetic patients with infarction and the role of insulin in myocardial adaptation to ischemia are both reviewed. Diabetic patients surviving the acute phase of myocardial infarction have a lower survival in follow-up than nondiabetic survivors, although some improvement in survival has been noted following beta-adrenergic-blocker therapy.

The clinical implications of diabetic heart disease

“…Interestingly, complaints of chest pain were more common in Type 2 diabetic patients than in normal controls, which is surprising considering the previous data suggesting chest pain may be less common for a given degree of ischaemia. In the meta-analysis by Kereiakes et al [23] , the risk of myocardial infarction was the same in men and women with diabetes but women had a 40% greater mortality. This is supported by data from Framingham, where Abbott et al [26] demonstrated that diabetes doubled the risk of recurrent myocardial infarction in women, compared with both normoglycaemic women and diabetic men.…”

“…Patients with diabetes who suffer a myocardial infarction have a poorer prognosis both acutely [21,22] and in the long term [23][24][25][26][27][28] . The Gotebö rg Trial [25] showed that the 5-year mortality post-myocardial infarction was 46% in diabetic population compared with 27% in normoglycaemic controls.…”

“…The Gotebö rg Trial [25] showed that the 5-year mortality post-myocardial infarction was 46% in diabetic population compared with 27% in normoglycaemic controls. A meta-analysis by Kereiakes [23] showed that diabetes increased the risk of fatal myocardial infarction (31% vs 19·5%), diabetic subjects vs normoglycaemic patients).…”

In Vivo Myocardial Protection From Ischemia/Reperfusion Injury by the Peroxisome Proliferator–Activated Receptor-γ Agonist Rosiglitazone

“…2 The increased mortality in patients with diabetes in the setting of acute myocardial infarction has been demonstrated in numerous studies, and the mortality after acute myocardial infarction in patients with diabetes is approximately twice that of nondiabetic patients. [2][3][4] A significant increase in the number of necrotic cardiomyocytes in ventricular myocardial biopsies obtained from diabetic patients was reported recently. 5 Rosiglitazone (ROSI, Avandia) is a peroxisome proliferatoractivated receptor-␥ (PPAR-␥) agonist and the most potent member of the thiazolidinedione antidiabetic agents and was recently approved by the FDA for treatment of type II diabetes mellitus.…”

Rosiglitazone Protects against Ischemia/Reperfusion-Induced Leukocyte Adhesion in the Zucker Diabetic Fatty Rat

“…Obesity, dyslipidemia, hypertension, and insulin resistance/glucose intolerance as well as a proinflammatory and prothrombotic state, characteristics of metabolic syndrome (Grundy et al, 2004), are thought to contribute to the accelerated atherosclerosis (Kannel and McGee, 1979;Uusitupa et al, 1993) and postmyocardial infarction mortality seen in type 2 diabetics (Kereiakes 1985;Woodfield et al, 1996). One of the potential mechanisms that may contribute to vascular disease in these patients is endothelial dysfunction, evidenced by impaired endothelium-dependent vasodilation and augmented responses to vasoconstrictors in preclinical models of metabolic syndrome (Walker et al, 1997(Walker et al, , 1999.…”