Copyright © 1990 by the European Society of Cardiology.
© 1990 The European Society of Cardiology
Diabetic patients and beta-blockers after acute myocardial infarction
*Division of Cardiology, Department of Medicine, University of California, San Diego Medical Center, Veterans Administration Hospital San Diego, California, U.S.A
The Naval Hospital of San Diego San Diego, California, U.S.A
Division of Cardiology, University of British Columbia Vancouver, Canada
Received 19 July 1988; revised 19 April 1989; .
Address for correspondence: John Kjekshus, M.d., Medical Department, Baerum Hospital, Oslo, Norway
Abstract
Whether diabetic patients may benefit, compared with non-diabetic patients, from beta-blocker therapy following acute myocardial infarction was examined in a large multicentre cohort of 2024 patients, including 340 diabetics, 281 of whom survived hospitalization. One-year mortality following discharge was 17% for diabetics compared with 10% for non-diabetics (P< 0-001). However, diabetics discharged on beta-blockers had a 1-year mortality of only 10%, compared with 23% for diabetics not on beta-blockers. In non-diabetics, mortality rates were 7% and 13% for those taking and not taking beta-blockers, respectively. Bias in patient selection for beta-blocker therapy might be responsible for the trends exhibited in our population since patients were not randomized to treatment. In diabetics, evidence of pulmonary congestion on X-ray was more prevalent than in non-diabetics; this appeared to be true both for patients taking beta-blockers and for those not taking beta-blockers. However, even in diabetics without evidence of pulmonary congestion on X-ray, 1-year mortality was 7% vs 17% for those with and without beta-blocker therapy, respectively (P<0-04). In multivariate analysis, beta-blocker use was an independent predictor of 1-year cardiac survival following hospital discharge for all diabetics, even those without evidence of pulmonary congestion on X-ray, but not for non-diabetics. These data suggest a beneficial effect, but a definitive answer regarding the benefit of beta-blockade in diabetic patients after acute myocardial infarction would require a prospective, randomized study
Key Words: Acute myocardial infarction • diabetes • beta-blockers
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. Triplitt and C. A. Alvarez Best Practices for Lowering the Risk of Cardiovascular Disease in Diabetes Diabetes Spectr, July 1, 2008; 21(3): 177 - 189. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. V. d. Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J. Suppl., June 1, 2007; 9(suppl_C): C3 - C74. [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J., January 1, 2007; 28(1): 88 - 136. [Full Text] [PDF]
|
|
|
|
|
|
F. Brigadeau, C. Kouakam, D. Klug, C. Marquie, A. Duhamel, F. Mizon-Gerard, D. Lacroix, and S. Kacet Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators Eur. Heart J., March 2, 2006; 27(6): 700 - 707. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. S.H. Bell The effectiveness of beta-blockers after myocardial infarction in patients with type 2 diabetes. Diabetes Care, February 1, 2006; 29(2): 483 - 483. [Full Text] [PDF]
|
|
|
|
|
|
C. G. McDonald, S. R. Majumdar, J. L. Mahon, and J. A. Johnson The Effectiveness of {beta}-Blockers After Myocardial Infarction in Patients With Type 2 Diabetes: Response to Bell Diabetes Care, February 1, 2006; 29(2): 483 - 484. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Asensio, M. Jimenez, F. Kuhne, F. Rohner-Jeanrenaud, and P. Muzzin The Lack of {beta}-Adrenoceptors Results in Enhanced Insulin Sensitivity in Mice Exhibiting Increased Adiposity and Glucose Intolerance Diabetes, December 1, 2005; 54(12): 3490 - 3495. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Li, A.-C. Jonsson-Rylander, K. Abe, and Z. Zukowska Chronic Stress Induces Rapid Occlusion of Angioplasty-Injured Rat Carotid Artery by Activating Neuropeptide Y and Its Y1 Receptors Arterioscler. Thromb. Vasc. Biol., October 1, 2005; 25(10): 2075 - 2080. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. G. McDonald, S. R. Majumdar, J. L. Mahon, and J. A. Johnson The Effectiveness of {beta}-Blockers After Myocardial Infarction in Patients With Type 2 Diabetes Diabetes Care, September 1, 2005; 28(9): 2113 - 2117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Task Force Members, J. Lopez-Sendo, K. Swedberg, J. McMurray, J. Tamargo, A. P. Maggioni, H. Dargie, M. Tendera, F. Waagstein, J. Kjekshus, et al. Expert consensus document on {beta}-adrenergic receptor blockers: The Task Force on Beta-Blockers of the European Society of Cardiology Eur. Heart J., August 1, 2004; 25(15): 1341 - 1362. [Full Text] [PDF]
|
|
|
|
 |
|
 M. J Everly, P. C Heaton, and R. J Cluxton Jr {beta}-Blocker Underuse in Secondary Prevention of Myocardial Infarction Ann. Pharmacother., February 1, 2004; 38(2): 286 - 293. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Li, E. W. Lee, H. Ji, and Z. Zukowska Neuropeptide Y-Induced Acceleration of Postangioplasty Occlusion of Rat Carotid Artery Arterioscler. Thromb. Vasc. Biol., July 1, 2003; 23(7): 1204 - 1210. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. R. Salpeter, T. M. Ormiston, and E. E. Salpeter Cardioselective {beta}-Blockers in Patients with Reactive Airway Disease: A Meta-Analysis Ann Intern Med, November 5, 2002; 137(9): 715 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Chyun, V. Vaccarino, J. Murillo, L. H. Young, and H. M. Krumholz Cardiac Outcomes After Myocardial Infarction in Elderly Patients With Diabetes Mellitus Am. J. Crit. Care., November 1, 2002; 11(6): 504 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Gheorghiade and S. Goldstein {beta}-Blockers in the Post-Myocardial Infarction Patient Circulation, July 23, 2002; 106(4): 394 - 398. [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, W. E. Mitch, R. W. Nesto, P. T. O'Gara, R. C. Becker, L. T. Clark, S. Hunt, I. Jialal, S. E. Lipshultz, and E. Loh Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group V: Management of Cardiovascular-Renal Complications Circulation, May 7, 2002; 105 (18): e159 - e164. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Zaugg, M. C. Schaub, T. Pasch, and D. R. Spahn Modulation of {beta}-adrenergic receptor subtype activities in perioperative medicine: mechanisms and sites of action Br. J. Anaesth., January 1, 2002; 88(1): 101 - 123. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. J. Mukamal, R. W. Nesto, M. C. Cohen, J. E. Muller, M. Maclure, J. B. Sherwood, and M. A. Mittleman Impact of Diabetes on Long-Term Survival After Acute Myocardial Infarction: Comparability of risk with prior myocardial infarction Diabetes Care, August 1, 2001; 24(8): 1422 - 1427. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-L. Pan, D. D. Deal, Z. Xu, and S.-R. Chen Differential responses of regional sympathetic activity and blood flow to visceral afferent stimulation Am J Physiol Regulatory Integrative Comp Physiol, June 1, 2001; 280(6): R1781 - R1789. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D.K McGuire, H Emanuelsson, C.B Granger, E Magnus Ohman, D.J Moliterno, H.D White, D Ardissino, J.W Box, R.M Califf, and E.J Topol Influence of diabetes mellitus on clinical outcomes across the spectrum of acute coronary syndromes. Findings from the GUSTO-IIb Study Eur. Heart J., November 1, 2000; 21(21): 1750 - 1758. [Abstract] [PDF]
|
|
|
|
 |
|
 R. H. Mehta, T. J. Ruane, P. A. McCargar, K. A. Eagle, and E. J. Stalhandske The Treatment of Elderly Diabetic Patients With Acute Myocardial Infarction: Insight From Michigan's Cooperative Cardiovascular Project Arch Intern Med, May 8, 2000; 160(9): 1301 - 1306. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Chen, T. A. Marciniak, M. J. Radford, Y. Wang, and H. M. Krumholz Beta-blocker therapy for secondary prevention of myocardial infarction in elderly diabetic patients: Results from the national cooperative cardiovascular project J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1388 - 1394. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Poothullil and M. I. Harris Diabetes and Decline in Heart Disease Mortality JAMA, September 22, 1999; 282(12): 1132 - 1132. [Full Text] [PDF]
|
|
|
|
|
|
E. Coodley Newer Drug Therapy for Congestive Heart Failure Arch Intern Med, June 14, 1999; 159(11): 1177 - 1183. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Towler, M. Bidder, T. Latifi, T. Coleman, and C. F. Semenkovich Diet-induced Diabetes Activates an Osteogenic Gene Regulatory Program in the Aortas of Low Density Lipoprotein Receptor-deficient Mice J. Biol. Chem., November 13, 1998; 273(46): 30427 - 30434. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. A Herity, R. H Mehta, K. A Eagle, R. Harrison, M. Burr, A. Nightingale, A. Marshall, J. F. Hansen, and R D Rice Secondary prevention in acute myocardial infarction BMJ, October 24, 1998; 317(7166): 1152a - 1152. [Full Text]
|
|
|
|
|
|
T. J. Wang and R. S. Stafford National Patterns and Predictors of {beta}-Blocker Use in Patients With Coronary Artery Disease Arch Intern Med, September 28, 1998; 158(17): 1901 - 1906. [Abstract] [Full Text]
|
|
|
|
 |
|
 S. S. Gottlieb, R. J. McCarter, and R. A. Vogel Effect of Beta-Blockade on Mortality among High-Risk and Low-Risk Patients after Myocardial Infarction N. Engl. J. Med., August 20, 1998; 339(8): 489 - 497. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. W. Nesto and S. Zarich Acute Myocardial Infarction in Diabetes Mellitus : Lessons Learned From ACE Inhibition Circulation, January 13, 1998; 97(1): 12 - 15. [Full Text] [PDF]
|
|