Comparison of secondary prevention measures after myocardial infarction in subjects with and without diabetes mellitus.
OBJECTIVE
To survey and compare secondary prevention measures in diabetic and non-diabetic patients following myocardial infarction (MI).


METHODS
Follow-up of a cohort of patients who suffered their first MI 1 year previously.


METHODS
Three district general hospitals.


METHODS
Review 1 year post-MI for signs of left ventricular failure (LVF), serum cholesterol, smoking status, weight, blood pressure and glycaemic control. Assessment of appropriate treatment with aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering therapy before discharge and at least 1 year post-MI.


RESULTS
A total of 189 non-diabetic and 86 diabetic patients were studied. Most patients received beta-blockers and aspirin appropriately, and most gave up smoking. In non-diabetic subjects, cholesterol fell significantly (P < 0.05), as did the proportion of patients with cholesterol > 5.5 mmol L(-1) (P < 0.05), whereas cholesterol did not fall significantly in diabetic subjects, due to a lower proportion of patients being on lipid-lowering therapy (27.5 vs. 37.9%). A higher proportion of non-diabetic patients with LVF were treated with ACE inhibitors compared with diabetic subjects (73.6 vs. 61.%). Glycaemic control did not improve in the diabetic subjects.


CONCLUSIONS
Patients with diabetes do not receive optimal secondary prevention measures compared with their non-diabetic counterparts. This issue needs to be addressed by all units dealing with patients with diabetes in order to reduce the mortality and morbidity of MI in such patients.
Department of Medicine, Birmingham Heartlands Hospital, UK.
T A
TA
Chowdhury
S S
SS
Lasker
P H
PH
Dyer
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D055502:Secondary Prevention; D016540:Smoking Cessation; D015431:Weight Loss
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001786:Blood Glucose; D001241:Aspirin