Diabetes Adds Fatal Risk to Acute Coronary Syndromes

August 15, 2007

BOSTON -- Diabetes added a significant independent risk of death for patients with acute coronary syndromes, such a ST-segment elevation myocardial infarction (STEMI) and non-STEMI or unstable angina, researchers reported.

BOSTON, Aug. 15 -- Diabetes added a significant independent risk of death for patients with acute coronary syndromes, such a ST-segment elevation myocardial infarction (STEMI) and non-STEMI or unstable angina, researchers here reported.

After adjustments, diabetes was found independently associated with an almost 80% increased risk of death at 30 days following a non-STEMI event or unstable angina, Elliott M. Antman, M.D., of Harvard, and colleagues, reported in the Aug. 15 issue of the Journal of the American Medical Association.

There was also a 40% increased risk of death at 30 days after a STEMI for diabetes patients, the investigators wrote.

After a year, the risk or mortality was 65% higher for those with diabetes and a STEMI, found the investigators. After a year for those with diabetes who had a non-STEMI event or unstable angina, the risk of death approached that of patients without diabetes who had had a STEMI (7.2% versus 8.1%).

Nearly 65% of those with diabetes die of cardiovascular disease in the U.S, but the independent effect of diabetes on the risk of death after an acute coronary event had been uncertain, Dr. Antman and colleagues wrote.

To evaluate it following an acute coronary event at 30 days and one year, the researchers turned to a subgroup analysis of patients with diabetes enrolled in randomized clinical trials that evaluated acute coronary syndrome therapies.

They pooled patients with acute coronary syndromes in 11 independent clinical trials from the Thrombolysis in Myocardial Infarction (TIMI) Study Group from 1997 to 2006.

These included 62,036 patients, 46,577 of them with STEMI and 15,459 with unstable angina or non-STEMI events. Of these 10,613 (17.1%) had diabetes.

Mortality at 30 days was significantly higher among patients with diabetes than without diabetes following either unstable angina or non-STEMI (2.1% versus 1.1%, P

Financial disclosures and funding support: The TIMI Study Group has received research/grant support in the last two years through the Brigham and Women's Hospital with funding from (in alphabetical order): Accumetrics, Amgen, AstraZeneca, Baxter, Bayer Healthcare LLC, Beckman Coulter, Biosite Incorporated, Bristol-Myers Squibb, CardioKinetix, CV Therapeutics, Eli Lilly, FoldRx, GlaxoSmithKline, INO Therapeutics, Inotek Pharmaceuticals, National Institutes of Health, Integrated Therapeutics Corporation, KAI Pharmaceuticals, Merck, Millennium Pharmaceuticals, Novartis, Nuvelo, Ortho-Clinical Diagnostics, Pfizer, Roche Diagnostics Corporation, Roche Diagnostics GmbH, Sanofi-Aventis, Sanofi-Synthelabo Recherche, Schering-Plough Research Institute, and St Jude Medical.