Mortality risk high among diabetes patients with prior CV events

By Laura Cowen

Patients with Type 2 diabetes and acute coronary syndromes (ACS) have a substantially increased risk of death in the 18 months after hospital admission for subsequent major nonfatal cardiovascular (CV) events, US researchers report.

The risk was particularly high for patients admitted with heart failure (HF), who were nearly five times more likely to die during the study than patients with Type 2 diabetes who were not readmitted to hospital with a major nonfatal CV event after an initial ACS.

Speaking to the press, lead researcher William White (University of Connecticut School of Medicine, Farmington) said: "Type 2 diabetes accompanied by an acute coronary syndrome needs much more attention, especially in order to prevent yet another major cardiac event".

"[T]he potential to reduce mortality through aggressive use of evidence-based secondary preventive therapies remains substantial and should be considered a standard in the clinical management of high CV risk patients with type 2 diabetes", write White and co-authors in Diabetes Care.

The researchers looked at mortality rates among 5380 participants of the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE) study, all of whom were randomly assigned to receive alogliptin or placebo at baseline, which occurred 15 to 90 days after an ACS.

During a median follow-up period of 18.8 months, 736 (13.7%) patients experienced a first nonfatal CV event: 316 (5.9%) had a myocardial infarction (MI), 204 (3.8%) had unstable angina, 159 (3.0%) had HF and 57 (1.1%) had a stroke.

Subsequent all-cause mortality rates after these CV events were highest in patients who had experienced HF first, at 27%, followed by MI (11.1%), stroke (10.5%) and unstable angina (4.4%). This compared with a mortality rate of 5.0% among the 4644 patients who did not experience any major CV events.

The researchers note that the mortality rates did not differ significantly between the alogliptin and placebo groups.

After adjustment for baseline differences between the groups, White and team found patients who experienced HF, MI and stroke had a significant 4.96-, 3.12- and 3.08-fold higher risk of death, respectively, than those who did not experience a CV event.

White described the results as "dramatic", noting in particular that hospitalisation for HF in a person with Type 2 diabetes was "a harbinger of a very poor outcome."

The authors conclude that their findings "demonstrate that heart failure should be a standard CV outcome, along with MI and stroke, in studies of patients with type 2 diabetes."

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