Aguilar David, Solomon Scott D, Køber Lars, Rouleau Jean-Lucien, Skali Hicham, McMurray John J V, Francis Gary S, Henis Marc, O'Connor Christopher M, Diaz Rafael, Belenkov Yuri N, Varshavsky Sergei, Leimberger Jeffrey D, Velazquez Eric J, Califf Robert M, Pfeffer Marc A
Cardiovascular Division, University of Texas Health Science Center, 6431 Fannin, MSB 1.246, Houston, TX 77030, USA.
Circulation. 2004 Sep 21;110(12):1572-8. doi: 10.1161/01.CIR.0000142047.28024.F2. Epub 2004 Sep 13.
A prior diagnosis of diabetes mellitus is associated with adverse outcomes after acute myocardial infarction (MI), but the risk associated with a new diagnosis of diabetes in this setting has not been well defined.
We assessed the risk of death and major cardiovascular events associated with previously known and newly diagnosed diabetes by studying 14,703 patients with acute MI enrolled in the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Patients were grouped by diabetic status: previously known diabetes (insulin use or diagnosis of diabetes before MI, n=3400, 23%); newly diagnosed diabetes (use of diabetic therapy or diabetes diagnosed at randomization [median 4.9 d after infarction], but no known diabetes at presentation, n=580, 4%); or no diabetes (n=10,719). Patients with newly diagnosed diabetes were younger and had fewer comorbid conditions than did patients with previously known diabetes. At 1 year after enrollment, patients with previously known and newly diagnosed diabetes had similarly increased adjusted risks of mortality (hazard ratio [HR] 1.43; 95% confidence interval [CI], 1.29 to 1.59 and HR, 1.50; 95% CI, 1.21 to 1.85, respectively) and cardiovascular events (HR, 1.37; 95% CI, 1.27 to 1.48 and HR, 1.34; 95% CI, 1.14 to 1.56).
Diabetes mellitus, whether newly diagnosed or previously known, is associated with poorer long-term outcomes after MI in high-risk patients. The poor prognosis of patients with newly diagnosed diabetes, despite having baseline characteristics similar to those of patients without diabetes, supports the idea that metabolic abnormalities contribute to their adverse outcomes.
既往糖尿病诊断与急性心肌梗死（MI）后的不良结局相关，但在此情况下新诊断糖尿病的风险尚未明确界定。
我们通过研究14703例急性MI患者评估了既往已知糖尿病和新诊断糖尿病相关的死亡风险及主要心血管事件，这些患者入选缬沙坦急性心肌梗死试验（VALIANT）。患者按糖尿病状态分组：既往已知糖尿病（MI前使用胰岛素或诊断为糖尿病，n = 3400，23%）；新诊断糖尿病（使用糖尿病治疗或随机分组时诊断为糖尿病[梗死中位数4.9天后]，但就诊时无已知糖尿病，n = 580，4%）；或无糖尿病（n = 10719）。新诊断糖尿病患者比既往已知糖尿病患者年轻且合并症较少。入组1年后，既往已知糖尿病和新诊断糖尿病患者调整后的死亡风险（风险比[HR]分别为1.43；95%置信区间[CI]为1.29至1.59和HR为1.50；95%CI为1.21至1.85）和心血管事件风险（HR分别为1.37；95%CI为1.27至1.48和HR为1.34；95%CI为1.14至1.56）均同样升高。
糖尿病，无论新诊断还是既往已知，在高危患者中均与MI后较差的长期结局相关。新诊断糖尿病患者尽管基线特征与无糖尿病患者相似，但其预后不良支持代谢异常导致其不良结局这一观点。
