European Heart Journal Advance Access originally published online on December 21, 2007
European Heart Journal 2008 29(2):177-184; doi:10.1093/eurheartj/ehm519
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Glucose lowering treatment in patients with coronary artery disease is prognostically important not only in established but also in newly detected diabetes mellitus: a report from the Euro Heart Survey on Diabetes and the Heart
1 Department of Cardiology, San Giovanni Battista—Molinette—Hospital, Turin 10126, Italy
2 Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
3 Munich Diabetes Research Institute, Neuherberg, Germany
Received 24 June 2007; revised 10 October 2007; accepted 18 October 2007; online publish-ahead-of-print 21 December 2007.
* Corresponding author. Tel: +46 8 51772171, Fax: +46 8 344964, Email: lars.ryden{at}ki.se
See page 141 for the editorial comment on this article (doi:10.1093/eurheartj/ehm595)
Aims: Glucose lowering (GL) therapy in patients with diabetes mellitus (DM) and coronary artery disease (CAD) is prognostically important. This report from the Euro Heart Survey on Diabetes and the Heart describes present practice in relation to 1 year prognosis.
Methods and results: The survey enrolled 4676 patients with CAD from 110 centres out of whom 1425 had known and 452 newly detected DM. The impact of different GL modalities on cardiovascular events (CVE: death, myocardial infarction, or stroke) was followed. Insulin treated patients with known DM (n = 378) had an adjusted 1 year hazard ratio (HR) for mortality of 2.23 (95% CI 1.24–4.03; P = 0.006) and for CVE of 1.27 (95% CI 0.85–1.87; P = 0.230) compared with those on oral GL drugs (n = 675). Of patients with newly detected DM 77 (17%) were started on GL drugs. None of them died compared with 25 (P = 0.002) among those without such treatment and their 1 year CVE HR was 0.22 (95% CI 0.05–0.97; P = 0.041) compared with untreated subjects.
Conclusion: Insulin therapy may relate to a more serious prognosis in CAD-patients with DM. There was a pronounced decrease in cardiovascular events in patients with newly detected DM prescribed GL drugs compared with those not receiving such treatment.
Key Words: Coronary artery disease • Diabetes mellitus • Newly detected diabetes • Insulin • Oral glucose lowering drugs • Mortality • Cardiovascular endpoints
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