In patients hospitalized for acute MI, diabetes raises risk for death
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Key takeaways:
- After an acute heart attack, those with diabetes were over 50% more likely to die after 1 year than those without.
- Patients with diabetes were less likely to receive appropriate therapies than those without.
Among patients hospitalized for acute MI, those with diabetes had greater risk for death than those without it, according to data from the Atherosclerosis Risk in Communities cohort.
The researchers sampled 21,094 hospitalizations for acute MI of Atherosclerosis Risk in Communities (ARIC) participants from 2000 to 2014.
“The burden of diabetes is increasing in the United States, and patients with diabetes are at increased risk of cardiovascular events,” Arman Qamar, MD, MPH, RPVI, FACC, interventional cardiologist and auxiliary research scholar at NorthShore Cardiovascular Institute, NorthShore Health System, Evanston, Illinois, told Healio. “There has been no recent report on the impact of presence of diabetes on mortality in patients presenting with MI.”
Among the cohort, the prevalence of diabetes increased from 35% in 2000-2004 to 41% in 2005-2009 and 43% in 2010-2014 (P for trend < .001), according to the researchers.
Compared with those without diabetes, those with it were older (61 years vs. 59 years; P < .0001), more often Black (44% vs. 31%; P < .0001) and more likely to be women (42% vs. 34%; P < .0001), Qamar and colleagues found.
Comorbidity burden was higher among those with diabetes and increased over time.
Those with diabetes were less likely to have STEMI (9% vs. 17%) and less likely to present with chest pain (72% vs. 80%), according to the researchers.
Patients with diabetes had higher scores than patients without diabetes in the following scales: Global Registry of Acute Coronary Syndrome score (GRACE; 123 vs. 109), TIMI score (4.3 vs. 4) and Killip class (1.9 vs. 1.5).
Risks and probabilities
Compared with those without diabetes, those with diabetes had lower adjusted probabilities of receiving aspirin (RR = 0.95; 95% CI, 0.91-0.99), receiving other antiplatelet therapies (RR = 0.93; 95% CI, 0.86-0.99), receiving coronary angiography (RR = 0.85; 95% CI, 0.78-0.92) and receiving coronary revascularization (RR = 0.85; 95% CI, 0.76-0.92), Qamar and colleagues found.
Risk for mortality at 1 year was more than 50% in those with diabetes than in those without it (HR = 1.52; 95% CI, 1.23-1.89).
“We expected that patients with diabetes would be at increased risk of mortality after MI,” Qamar told Healio. “However, we were surprised that patients with diabetes were not receiving evidence-based therapy for MI, likely coronary revascularization. The reason for this could be that patients with diabetes have diffuse disease and complex coronary anatomy. We were also surprised to find that the use of evidence-based therapy was lesser in patients with diabetes. Recent studies have found that diabetes drugs like SGLT2 inhibitors and GLP-1 receptor agonists improve outcomes in patients with atherosclerotic cardiovascular diseases, but they remain underutilized.”
In addition to patients with ASCVD receiving SGLT2 inhibitors or GLP-1 receptor agonists, “if not contraindicated, patients with diabetes and MI should be treated with coronary revascularization, and adherence to evidence-based therapies should be emphasized,” Qamar told Healio. “At our health system, we have established one of the first cardio-diabetes programs in the United States, in which our expert pharmacists work closely with the cardiovascular and endocrine physicians to promote utilization of evidence-based therapies.”
‘Providers have the power’
In a related editorial, Layla A. Abushamat, MD, MPH, instructor in medicine at Baylor College of Medicine, and Vijay Nambi, MD, PhD, associate professor of medicine at Baylor College of Medicine and staff cardiologist at Michael E. DeBakey Veterans Affairs Hospital, wrote that data from the GOULD registry show that only 6.9% of patients with diabetes are on guideline-directed medical therapy for secondary prevention, and thus efforts to prevent ASCVD in patients with diabetes “must occur at societal, system, provider and individual levels and in varied settings, including outpatient and inpatient care.”
Cardiometabolic clinics involving multidisciplinary teams may be a solution, as these teams “could see patients in the hospital or in close outpatient follow-up of hospitalization to tackle several barriers and to initiate, deliver and manage optimal evidence-based cardiometabolic preventive therapy,” they wrote. “Ultimately, through appropriate identification of high-risk patients, counseling, prescribing guideline-directed medical therapy and addressing barriers, providers have the power to improve the morbidity and mortality of those with diabetes.”
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For more information:
Arman Qamar, MD, MPH, RPVI, FACC, can be reached at aqamar@northshore.org; Twitter: @aqamarmd.
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