Diabetes Mellitus and Acute Myocardial Infarction: Impact on Short and Long-Term Mortality
Diabetes mellitus (DM) is an important risk factor for acute myocardial infarction (AMI) and a frequent co-morbidity in patients hospitalized with AMI, being present in about 30% of cases. Although current treatment of AMI has considerably improved surviv
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Diabetes Mellitus and Acute Myocardial Infarction: Impact on Short and Long-Term Mortality Valentina Milazzo, Nicola Cosentino, Stefano Genovese, Jeness Campodonico, Mario Mazza, Monica De Metrio, and Giancarlo Marenzi still differentiates AMI patients with DM from those without.
Abstract
Diabetes mellitus (DM) is an important risk factor for acute myocardial infarction (AMI) and a frequent co-morbidity in patients hospitalized with AMI, being present in about 30% of cases. Although current treatment of AMI has considerably improved survival in both patients with and without DM, the presence of DM still doubles the case fatality rate during both the acute phase of AMI and at long-term follow-up. This higher mortality risk of DM patients strongly indicates a particular need for better treatment options in these patients and suggests that intensive medical treatment, prolonged surveillance, and stringent control of other risk factors should be carefully pursued and maintained for as long as possible in them. In this review, we will focus on the close association between DM and in-hospital and long-term mortality in AMI patients. We will also aim at providing current evidence on the mechanisms underlying this association and on emerging therapeutic strategies, which may reduce the traditional mortality gap that
V. Milazzo, N. Cosentino, S. Genovese, J. Campodonico, M. Mazza, M. De Metrio, and G. Marenzi (*) Centro Cardiologico Monzino IRCCS, Milan, Italy e-mail: [email protected]
Keywords
Acute hyperglycemia · Acute myocardial infarction · Diabetes mellitus · In-hospital mortality · Long-term mortality · Non-STelevation myocardial infarction · Percutaneous coronary intervention · Pre-diabetes mellitus · ST-elevation myocardial infarction · Unknown diabetes mellitus
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Introduction
Diabetes mellitus (DM), in particular type 2 DM, constitutes one of the largest emerging threats to health in the twenty-first century. It is estimated that by 2030 as many as 360 million people world-wide will be affected (Wild et al. 2004). The cause of death in patients with DM is largely due to coronary artery disease (CAD), along with increased rates of stroke and peripheral vascular disease: the so called macro-vascular complications (Kannel and McGee 1979). Notably, at least two-thirds of deaths in DM patients are due to athero-thrombotic events and their sequelae (Fuller et al. 1983; Geiss et al. 1995). Compared to individuals without DM, those with DM have a three-fold increased risk of acute
V. Milazzo et al.
myocardial infarction (AMI), which usually occurs 15 years earlier, as compared to their non-DM counterpart (Haffner 2000; Booth et al. 2006). Moreover, AMI may even represent the first clinical manifestation of DM (Norhammar et al. 2002). Indeed, in about 5–10% of AMI patients, the presence of DM, until then unknown, is detected during index hospitalization (Marenzi et al. 2018a). Not onl
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