title: Impact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndromes.
abstract: OBJECTIVE
  To determine whether previous insulin treatment independently influences subsequent outcomes in diabetic patients with ACS (acute coronary syndromes).
  
  
  METHODS
  375 diabetic patients with ACS, divided in 2 groups: Group A (n = 69)--previous insulin and Group B (n = 306)--without previous insulin. Predictors of 1-year mortality and major adverse cardiac events (MACE) were analyzed by Cox regression analysis.
  
  
  RESULTS
  Group A had more previous stroke (17.4% vs. 9.2%, p = 0.047) and peripheral artery disease (13.0% vs. 3.6%, p = 0.005). They had significantly higher admission glycemia and lower LDL cholesterol. There were no significant differences in the type of ACS, in 1-year mortality (18.2% vs. 10.4%, p = 0.103) or MACE (32.1% vs. 23.0%, p = 0.146) between groups. In multivariate analysis, insulin treatment was neither an independent predictor of 1-year mortality nor of MACE.
  
  
  CONCLUSIONS
  Despite the more advanced atherosclerotic disease, diabetics under insulin had similar outcomes to those without insulin. Insulin may protect diabetics from the expected poor adverse outcome of an advanced atherosclerotic disease.
authors.affiliation: Cardiology Department, Coimbra University Hospital, Portugal. natalia.antonio@gmail.com
authors.forename: Natália
authors.initials: N
authors.lastname: António
authors.forename: Francisco
authors.initials: F
authors.lastname: Soares
authors.forename: Carolina
authors.initials: C
authors.lastname: Lourenço
authors.forename: Fátima
authors.initials: F
authors.lastname: Saraiva
authors.forename: Francisco
authors.initials: F
authors.lastname: Gonçalves
authors.forename: Pedro
authors.initials: P
authors.lastname: Monteiro
authors.forename: Lino
authors.initials: L
authors.lastname: Gonçalves
authors.forename: Mário
authors.initials: M
authors.lastname: Freitas
authors.forename: Luís A
authors.initials: LA
authors.lastname: Providência
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D007328:Insulin