Newly diagnosed and previously known diabetes mellitus and 1-year outcomes of acute myocardial infarction: the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial.
BACKGROUND
A prior diagnosis of diabetes mellitus is associated with adverse outcomes after acute myocardial infarction (MI), but the risk associated with a new diagnosis of diabetes in this setting has not been well defined.


RESULTS
We assessed the risk of death and major cardiovascular events associated with previously known and newly diagnosed diabetes by studying 14,703 patients with acute MI enrolled in the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Patients were grouped by diabetic status: previously known diabetes (insulin use or diagnosis of diabetes before MI, n=3400, 23%); newly diagnosed diabetes (use of diabetic therapy or diabetes diagnosed at randomization [median 4.9 d after infarction], but no known diabetes at presentation, n=580, 4%); or no diabetes (n=10,719). Patients with newly diagnosed diabetes were younger and had fewer comorbid conditions than did patients with previously known diabetes. At 1 year after enrollment, patients with previously known and newly diagnosed diabetes had similarly increased adjusted risks of mortality (hazard ratio [HR] 1.43; 95% confidence interval [CI], 1.29 to 1.59 and HR, 1.50; 95% CI, 1.21 to 1.85, respectively) and cardiovascular events (HR, 1.37; 95% CI, 1.27 to 1.48 and HR, 1.34; 95% CI, 1.14 to 1.56).


CONCLUSIONS
Diabetes mellitus, whether newly diagnosed or previously known, is associated with poorer long-term outcomes after MI in high-risk patients. The poor prognosis of patients with newly diagnosed diabetes, despite having baseline characteristics similar to those of patients without diabetes, supports the idea that metabolic abnormalities contribute to their adverse outcomes.
Aguilar
David
D
Cardiovascular Division, University of Texas Health Science Center, 6431 Fannin, MSB 1.246, Houston, TX 77030, USA. david.aguilar@uth.tmc.edu
Solomon
Scott D
SD
Køber
Lars
L
Rouleau
Jean-Lucien
JL
Skali
Hicham
H
McMurray
John J V
JJ
Francis
Gary S
GS
Henis
Marc
M
O'Connor
Christopher M
CM
Diaz
Rafael
R
Belenkov
Yuri N
YN
Varshavsky
Sergei
S
Leimberger
Jeffrey D
JD
Velazquez
Eric J
EJ
Califf
Robert M
RM
Pfeffer
Marc A
MA
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D002216:Captopril / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D048909:Diabetes Complications / Q000401:mortality*; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015993:Life Tables; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012306:Risk; D020521:Stroke / Q000453:epidemiology; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D013777:Tetrazoles; D000068756:Valsartan; D002216:Captopril; D014633:Valine