title: Factors Associated With Cardiovascular Events in Patients With Type 2 Diabetes and Acute Myocardial Infarction.
abstract: BACKGROUND
  Decreasing risk of cardiovascular (CV) disease remains a challenge to survival in type 2 diabetes.
  
  
  OBJECTIVE
  The objective was to assess the association between demographic, glycemic, and other clinical factors and CV risk in the Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus trial. DESIGN, SETTINGS, PARTICIPANTS, AND INTERVENTION: We used discrete-time survival tree analysis to examine data collected for up to 4.6 years in 1115 patients with type 2 diabetes mellitus experiencing acute myocardial infarction (MI) less than or equal to 18 days before enrollment.
  
  
  METHODS
  The primary objective was to identify demographic, glycemic, and CV risk factors best separating survival curves over time for a composite end point: CV death, nonfatal MI, nonfatal stroke, hospitalization for acute coronary syndromes, or coronary revascularization planned after randomization.
  
  
  RESULTS
  Average change across visits in mean 2-hour blood glucose level after meals was associated with the greatest difference in event-free survival probability for the primary end point: mean time to 75% event-free survival for an average change across visits less than or equal to -0.14 mmol/L, 73.48 weeks; for visits with average change more -0.14 mmol/L, 29.10 weeks. An average change across visits in the hemoglobin A1c level less than or equal to -0.92% (-10.06 mmol/mol) and the absence of a history of stroke or acute MI increased CV event-free survival time further. Fasting blood glucose and randomized insulin treatment strategy were weak predicting factors of event-free survival.
  
  
  CONCLUSIONS
  Postprandial glycemia should be considered a potential target in trials to reduce CV morbidity and mortality in type 2 diabetes mellitus.
authors.affiliation: Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Strojek
authors.affiliation: Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria.
authors.forename: Itamar
authors.initials: I
authors.lastname: Raz
authors.affiliation: Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria.
authors.forename: György
authors.initials: G
authors.lastname: Jermendy
authors.affiliation: Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria.
authors.forename: Anselm K
authors.initials: AK
authors.lastname: Gitt
authors.affiliation: Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria.
authors.forename: Rong
authors.initials: R
authors.lastname: Liu
authors.affiliation: Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria.
authors.forename: Qianyi
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Jacober
authors.affiliation: Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria.
authors.forename: Zvonko
authors.initials: Z
authors.lastname: Milicevic
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D023381:Endpoint Determination; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin