Diabetes exacerbates long-term CV risks after MI for younger adults
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Among adults who experience a myocardial infarction at age 50 years or younger, those with diabetes have greater all-cause and cardiovascular mortality risks compared with those without diabetes, according to findings published in Diabetes Care.
“Diabetes is an important risk factors for myocardial infarction among young individuals, and compared with patients who did not have diabetes, the presence of diabetes — and particularly insulin-dependent diabetes — is associated with significantly worse cardiovascular outcomes over long-term follow-up,” Ron Blankstein, MD, a preventive cardiologist at Brigham and Women's Hospital and an associate professor of medicine and radiology at Harvard Medical School, told Endocrine Today.
Blankstein and colleagues used electronic health records that were logged from 2000 to 2016 at Brigham and Women’s Hospital and Massachusetts General Hospital to identify 2,097 instances of MI in adults aged 50 years or younger. The researchers reported that 20% of these MIs occurred in adults with diabetes (mean age, 45 years; 23.1% women) and 80% occurred in adults without diabetes (mean age, 45 years; 18.3% women). Among those with diabetes, 41% used insulin.
Once the two cohorts were identified, the researchers used EHRs and data from the Social Security Administration Death Master File and the National Death Index to identify all-cause mortality and CV mortality outcomes, which were used to calculate risk. Median follow-up was 11.2 years.
Adjusted all-cause mortality risk was 1.65 times greater for individuals with diabetes compared with individuals without diabetes (HR = 1.65; 95% CI, 1.14-2.38). Adjusted CV mortality risk was 2.1 times greater for individuals with diabetes compared with individuals without diabetes (HR = 2.1; 95% CI, 1.26-3.49). In addition, adjusted all-cause mortality risk for those with preexisting diabetes (excluding newly diagnosed cases) was 1.93 times greater than the risk for those without diabetes (HR = 1.93; 95% CI, 1.38-2.7). Adjusted all-cause CV mortality risk for those with preexisting diabetes was 2.39 times greater than the risk for those without diabetes (HR = 2.39; 95% CI, 1.4-4.07).
Adjusted all-cause mortality risk was doubled for those with diabetes who used insulin compared with those without diabetes (HR = 2; 95% CI, 1.28-3.13), but the researchers wrote that the increased risk for those who did not use insulin did not reach significance. However, adjusted CV mortality risk was 2.31 times greater for those who used insulin (HR = 2.31; 95% CI, 1.22-4.38) and 2.03 times greater for those who did not use insulin (HR = 2.03; 95% CI, 1.04-3.96) compared with those who did not have diabetes.
When compared with those without diabetes, A higher proportion of those with vs. without diabetes were hospitalized for heart failure (4.8% vs. 1.5%; P < .001). Risk for heart failure hospitalization in the year after MI was more than doubled for those with diabetes vs. those without (HR = 2.12; 95% CI, 1.13-3.99).
“The implications are that these individuals should be treated even more aggressively,” Blankstein said. – by Phil Neuffer
Disclosures: Blankstein reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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