Don’t Dismiss Diabetes: Long-Term Mortality After Acute MI Linked With the Disease in Large Population Study

Diabetes is likely an even greater risk factor for mortality after acute MI than previously thought, according to a large population-based cohort study.

One of the most common comorbidities for patients with heart disease, diabetes and its effects on this population have long been chronicled in the literature. But comprehending the extent to which diabetes affects survival post-acute MI “is of great importance because nowadays deaths following [acute] MI are mostly due to noncardiovascular causes,” write lead author Oras Alabas, PhD (University of Leeds, England), and colleagues.

Their study looked at 281,259 STEMI and 422,661 NSTEMI patients treated in England and Wales, 17.1% of whom had diabetes, between January 2003 and June 2013. Over an 8.4 year follow-up and a total of 1.94 million person-years, there were 187,875 deaths. In all, 26.7% of patients died, with a higher rate of all-cause death recorded in diabetics (35.8%) compared with nondiabetics (25.3%).

After adjustment for age, sex, and year of acute MI, diabetes was linked with a 72% and 67% greater chance of dying after STEMI and NSTEMI, respectively. This relationship was further confirmed even after adjusting for additional comorbidity, risk factors, and cardiovascular treatments.

The study was published online June 15, 2016, ahead of print in the Journal of Epidemiology and Community Health.

In an email, senior author Chris Gale, PhD (University of Leeds), told TCTMD that because patients are living longer due to improvements in post-MI care, it is important to home in on the reasons why they are eventually dying. “We know that certain other diseases impact outcomes after a heart attack, and that, for example, diabetes, a long-term condition, increases the risk of heart attack,” he said. “But does it affect outcomes after heart attack?”

Gale said they suspected that diabetes would have a direct relationship with short-term post-MI mortality, but the long-term association was surprising.

What could have strengthened the findings would have been information on prescriptions, diabetes control, and healthcare utilization after discharge, according to Gale. Additionally, future research should focus on longitudinal survival data following heart attack in more large-scale populations, he said.

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