Diabetes, hypertension, and renal insufficiency in post-myocardial infarction cardiovascular risk.

The prognosis for patients who suffer myocardial infarctions (MIs) is poor, with 22% of male and 46% of female survivors being disabled by heart failure within 6 years. Many well-established risk factors for increased morbidity and mortality post-MI are closely linked to the metabolic syndrome and associated with over-activation of the renin-angiotensin-aldosterone and sympathetic nervous systems. Results from numerous large-scale clinical endpoint trials have shown that blocking the deleterious effects of these systems with either an angiotensin-converting enzyme inhibitor or a beta-adrenoceptor antagonist significantly reduces the risk of mortality and cardiovascular events in post-MI patients. Results from 1 recent study of the beta-blocker, carvedilol, have shown further that these benefits extend to high-risk patients with either diabetes or hypertension.