Effect of diabetes mellitus and its treatment on ventricular arrhythmias complicating acute myocardial infarction.
OBJECTIVE
To evaluate the effect of diabetes mellitus and its treatment on the risk of arrhythmias among early survivors of acute myocardial infarction.


METHODS
The Onset Study was conducted in 64 US medical centres. Between August 1989 and September 1996, 3882 patients were interviewed after having an acute myocardial infarction. We used logistic regression models to examine the association of diabetes and its treatment with the risk of ventricular arrhythmia after adjustment for age, gender, hypertension, thrombolytic therapy, smoking, obesity, cardiac medicines and congestive heart failure.


RESULTS
During the index hospitalization, patients with diabetes (n=814) were less likely to develop ventricular arrhythmias than patients without diabetes (6.8 vs. 13.3%, P<0.001). The risk of ventricular arrhythmia in patients treated with first generation sulphonylureas or diet alone was similar to patients without diabetes (OR=0.91; 95% CI, 0.39-2.15, and 0.76; 95% CI, 0.46-1.26, respectively). However, compared with patients without diabetes, the adjusted odds ratio (OR) for ventricular arrhythmias was lower among patients treated with insulin or patients treated with second generation sulphonylureas (OR=0.54, 95% CI 0.32-0.92; OR=0.45, 95% CI 0.27-0.75, respectively).


CONCLUSIONS
Compared with patients without diabetes, the risk of ventricular arrhythmias complicating acute myocardial infarction is lower in patients with diabetes treated with second generation sulphonylureas or insulin, but not in those treated with first generation sulphonylureas or diet alone. This suggests that differences in the mechanism of action of different sulphonylureas may result in clinically relevant differences in arrhythmic risk.
Rana
J S
JS
Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Mukamal
K J
KJ
Nesto
R W
RW
Morgan
J P
JP
Muller
J E
JE
Mittleman
M A
MA
D000208:Acute Disease; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D003925:Diabetic Angiopathies / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D013453:Sulfonylurea Compounds / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology
D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds