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(Circulation. 2004;110:1572-1578.)
© 2004 American Heart Association, Inc.

Coronary Heart Disease

Newly Diagnosed and Previously Known Diabetes Mellitus and 1-Year Outcomes of Acute Myocardial Infarction

The Valsartan in Acute Myocardial Infarction (VALIANT) Trial

David Aguilar, MD; Scott D. Solomon, MD; Lars Køber, MD, DSc; Jean-Lucien Rouleau, MD; Hicham Skali, MD; John J.V. McMurray, MD; Gary S. Francis, MD; Marc Henis, MD; Christopher M. O’Connor, MD; Rafael Diaz, MD; Yuri N. Belenkov, MD, PhD; Sergei Varshavsky, MD; Jeffrey D. Leimberger, PhD; Eric J. Velazquez, MD; Robert M. Califf, MD; Marc A. Pfeffer, MD, PhD

From the University of Texas Health Science Center, Houston (D.A.); Brigham and Women’s Hospital, Boston, Mass (S.D.S., H.S., M.A.P.); Rigshospitalet, Copenhagen, Denmark (L.K.); Toronto Hospital, Toronto, Ontario, Canada (J.L.R.); University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); The Cleveland Clinic Foundation, Cleveland, Ohio (G.S.F.); Medical Pharmaceutical Consultants, Randolph, NJ (M.H.); Duke Clinical Research Institute, Durham, NC (C.M.O., J.D.L., E.J.V, R.M.C.); Estudios Cardiologicos Latinoamerica, Santa Fe, Argentina (R.D.); Cardiology Research Institute, Moscow, Russia (Y.N.B.); and the CPR/Research Institute of Cardiology, St. Petersburg, Russia (S.V.).

Correspondence and reprint requests to Dr David Aguilar, Cardiovascular Division, University of Texas Health Science Center, 6431 Fannin, MSB 1.246, Houston, TX 77030. E-mail david.aguilar{at}uth.tmc.edu

Received January 29, 2004; revision received April 29, 2004; accepted May 18, 2004.

Background— 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.

Methods and Results— 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).

Conclusions— 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.

Key Words: myocardial infarction • prognosis • diabetes mellitus • heart failure

Find additional patient-related information at:

Who is at Greater Risk for Heart Problems: Newly or Previously Diagnosed Patients With Diabetes?

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