Impact of Diabetes on Long-Term Survival After Acute Myocardial Infarction
Comparability of risk with prior myocardial infarction
- Kenneth J. Mukamal, MD, MPH, MA1,
- Richard W. Nesto, MD2,
- Mylan C. Cohen, MD, MPH3,
- James E. Muller, MD4,
- Malcolm Maclure, SCD5,
- Jane B. Sherwood, RN6 and
- Murray A. Mittleman, MD, DRPH57
- 1Division of General Medicine and Primary Care at the Beth Israel Deaconess Medical Center, Boston, Massachusetts
- 2Department of Cardiovascular Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts
- 3Division of Cardiology, Maine Medical Center, Portland, Maine
- 4Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; the Departments of
- 5Epidemiology and
- 6Health and Social Behavior, Harvard School of Public Heath, Boston, Massachusetts
- 7Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Abstract
OBJECTIVE—To determine the effect of diabetes on long-term survival after acute myocardial infarction and to compare its effect with that of a previous myocardial infarction.
RESEARCH DESIGN AND METHODS—In a prospective cohort study, we followed 1,935 patients hospitalized with a confirmed acute myocardial infarction at 45 U.S. medical centers between 1989 and 1993, as part of the Determinants of Myocardial Infarction Onset Study. Trained interviewers performed chart reviews and face-to-face interviews with all patients. We analyzed survival using Cox proportional hazards regression to control for potentially confounding factors.
RESULTS—Of the 1,935 patients, 320 (17%) died during a mean follow-up of 3.7 years. A total of 399 patients (21%) had previously diagnosed diabetes. Diabetes was associated with markedly higher total mortality in unadjusted (hazard ratio [HR] 2.4; 95% CI 1.9–3.0) and adjusted (1.7; 1.3–2.1) analyses. The magnitude of the effect of diabetes was identical to that of a previous myocardial infarction. The effect of diabetes was not significantly modified by age, smoking, household income, use of thrombolytic therapy, type of hypoglycemic treatment, or duration of diabetes, but the risk associated with diabetes was higher among women than men (adjusted HRs 2.7 vs. 1.3, P = 0.01).
CONCLUSIONS—Diabetes is associated with markedly increased mortality after acute myocardial infarction, particularly in women. The increase in risk is of the same magnitude as a previous myocardial infarction and provides further support for aggressive treatment of coronary risk factors among diabetic patients.
Footnotes
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Address correspondence and reprint requests to Kenneth J. Mukamal, MD, MPH, MA, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, LY-303, Boston, MA 02215. E-mail: kmukamal{at}caregroup.harvard.edu.
Received for publication 16 January 2001 and accepted in revised form 3 April 2001.
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