Antiplatelet treatment reduced mortality among patients with diabetes

Among patients with diabetes, clopidogrel treatment after myocardial infarction led to lower reductions in all-cause death and cardiovascular death compared with patients without diabetes, according to study results.

Specifically, clopidogrel was associated with a RR reduction of 25% for all-cause mortality, 23% for cardiovascular mortality, and 9% for both recurrent MI and all-cause mortality in patients without diabetes. Among patients with diabetes, however, there was a RR reduction of 11% for all-cause mortality and no significant reduction in cardiovascular mortality.

Researchers linked data from Danish nationwide administrative registries from 2002 to 2009 among patients who were hospitalized with MI and who had survived and not undergone coronary artery bypass grafting 30 days after discharge. The trial included 58,851 patients, 7,247 (12%) with diabetes and 35,380 (60%) who received clopidogrel.

In all, 1,790 patients (25%) with diabetes and 7,931 patients (15%) without diabetes met the composite endpoint of recurrent MI and all-cause mortality. Of these, 1,225 (17%) with and 5,377 (10%) without diabetes died. In addition, 978 patients (80%) with diabetes and 4,100 patients (76%) without diabetes died of cardiovascular events.

Patients with diabetes who were treated with clopidogrel had an unadjusted mortality rate (events per 100 person-years) of 13.4 (95% CI, 12.8-14) compared with 29.3 (95% CI, 28.3-30.4) for those not treated. After examining patients without diabetes who were treated with clopidogrel, researchers observed an unadjusted mortality rate of 6.4 (95% CI, 6.3-6.6) compared with 21.3 (95% CI, 21-21.7) for those not treated with the drug.

The study highlights the elevated risk of recurrent MI and cardiovascular mortality among patients with diabetes after MI, Deepak L. Bhatt, MD, MPH, professor of medicine at Harvard Medical School in Boston, wrote in an accompanying editorial.

“More needs to be done to reduce these risks among such patients,” he said. “At least a portion of this excess risk appears due to platelet activity and function and to the effects of antiplatelet medications in patients with diabetes. Therefore, in appropriately selected patients, intensification of the antiplatelet regimen may be one method by which their outcomes might be markedly improved.”