title: Impact of diabetes on long-term survival after acute myocardial infarction: comparability of risk with prior myocardial infarction.
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.
  
  
  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.
authors.affiliation: Division of General Medicine and Primary Care at the Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. kmukamal@caregroup.harvard.edu
authors.forename: K J
authors.initials: KJ
authors.lastname: Mukamal
authors.forename: R W
authors.initials: RW
authors.lastname: Nesto
authors.forename: M C
authors.initials: MC
authors.lastname: Cohen
authors.forename: J E
authors.initials: JE
authors.lastname: Muller
authors.forename: M
authors.initials: M
authors.lastname: Maclure
authors.forename: J B
authors.initials: JB
authors.lastname: Sherwood
authors.forename: M A
authors.initials: MA
authors.lastname: Mittleman
mesh_terms: D000368:Aged; D015331:Cohort Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States