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Influence of Diabetes on Mortality and Cardiovascular Risk

This study examines the impact of diabetes on mortality rates and cardiovascular risk in patients with and without diabetes. The results show a higher mortality rate in patients with diabetes after percutaneous coronary intervention (PCI). Additionally, the study evaluates the effects of admission blood glucose on survival in acute myocardial infarction (AMI) patients without diabetes. The findings suggest a negative effect of high blood glucose levels on survival. The study also explores the influence of glucose control on all-cause mortality in patients with diabetes, showing the benefit of intensive treatment. Furthermore, the guidelines for the diagnosis and treatment of acute and chronic heart failure in patients with diabetes are presented, highlighting the importance of managing co-morbidities such as renal dysfunction.

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Influence of Diabetes on Mortality and Cardiovascular Risk

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  1. dr.med.habil. Simon KornélA diabeteszes szív

  2. *Insulin-treated *All Patients with Diabetes *Non-insulin-treated *Patients without Diabetes *Patients with Diabetes J Am Coll Cardiol 1997;30: 171-9.

  3. One-year mortality in diabetics and nondiabetics with non STE ACS after PCI Diabetic/PL (n=574) Diabetic/ABX (n=888) Non Diabetic/PL (n=1850) Non Diabetic/ABX (n=3222) P=0.031 JACC, 2000. 35:925.

  4. Wilson PWF , Kannel WB , Epidemiology of hyperglycemia and atherosclerosis. Hyperglycemia, Diabetes, and Vascular Disease. Ruderman N, Williamson J, Brownlee M New York Oxford 1992 p 21 ~ 29

  5. low BG high BG 2P=0.0069 (Log-Rank test) Effect of admission BG on survival of AMI pts without DM Diab. Care, 1999. 22: 1829.

  6. Effect of FBG or DM on survival of pts after PCI FBG>7.0 NFG IFG ADA-DM CDM Am. Heart J. 2003. 146: 354.

  7. GIK No GIK P=0.04 (Log-Rank test) Survival of diabetic pts after CABG with vs. without GIK treatment Circulation, 2004. 109: 1500.

  8. Kaplan-Meier rates for participants with diabetes Myocardial infarction Stroke 0.16 0.08 Placebo Ramipril 0.12 0.06 0.08 0.04 0.04 0.02 p<0,05 p<0,05 0.00 0.00 0 500 1000 1500 2000 0 500 1000 1500 2000 Duration of follow-up (days) HOPE, Lancet, 355: 255.2000.

  9. Effects of reduction of LDL-cholesterol on coronary heart disease event rate Lancet, 2006, 367:73

  10. UKPDS – blood glucose Time from randomisation (years) Time from randomisation (years) intensive control conventional control Time from randomisation (years) Lancet, 1998:352, 847

  11. All-cause mortality Diab. Care, 26: 692, 2003.

  12. * * b a * * * * * * Influence of indices of intra-abdominal adiposity on CVR EHJ Suppl. 2006; 8: B24

  13. 15,4 20,3 EHJ Suppl. 2006. 8: B21 SAHS

  14. Effect of diabetes on probability of 30-day mortality JACC, 28:166, 1996

  15. Ventricular Remodeling in Diastolic and Systolic heart failure

  16. UKPDS - Glucose Control Study Overweight patients HbA1C 9 Conventional Insulin Chlorpropamide Glibenclamide Metformin 8 HbA1C(%) 7 6 0 0 2 4 6 8 10 Years from randomisation Results presented by the UKPDS group, EASD 34th congress, Barcelona, September 10-11, 1998

  17. Endpoint among pts assigned to metformin, intensive or conventional treatment Lancet 1998, 352:861 UKPDS

  18. „ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008”[Eur Heart J 2008;29:2388-2442 and Eur J Heart Fail 2008;10:933-989] The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Authors/Task Force Members: Kenneth Dickstein (Chairperson) (Norway)*, Alain Cohen-Solal (France), Gerasimos Filippatos (Greece), John J.V. McMurray (UK), Piotr Ponikowski (Poland), Philip Alexander Poole-Wilson (UK), Anna Strömberg (Sweden), Dirk J. van Veldhuisen (The Netherlands), Dan Atar (Norway), Arno W. Hoes (The Netherlands), Andre Keren (Israel), Alexandre Mebazaa (France), Markku Nieminen (Finland), Silvia Giuliana Priori (Italy), Karl Swedberg (Sweden)

  19. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full texts The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Authors/Task Force Members, Lars Rydén, Co-Chairperson (Sweden)", Eberhard Standl, Co-Chairperson (Germany)", Malgorzata Bartnik (Poland), Greet Van den Berghe (Belgium), John Betteridge (UK), Menko-Jan de Boer (The Netherlands), Francesco Cosentino (Italy), Bengt Jönsson (Sweden), Markku Laakso (Finland), Klas Malmberg (Sweden), Silvia Priori (Italy), Jan Östergren (Sweden), Jaakko Tuomilehto (Finland), Inga Thrainsdottir (Iceland) Other Contributors, use Vanhorebeek (Belgium), Marco Stramba-Badiale (Italy), Peter Lindgren (Sweden) Sing Qiao (Finland) ESC Committee for Practice Guidelines (CPG), Silvia G. Priori, Chairperson (Italy), Jean-Jacques Blanc (France), Andrzej Budaj (Poland), John Comm (UK), Veronica Dean (France), Jaap Deckers (The Netherlands), Kenneth Dickstein (Norway), John Lekakis (Greece), Keith McGregor (France), Marco Metra (Italy), João Morais (Portugal), Ady Osterspey (Germany), Juan Tamargo (Spain), Josè Luis Zamorano (Spain) Document Reviewers, Jaap W. Deckers, CPG Review Coordinator (The Netherlands), Michel Bertrand (France), Bernard Charbonnel (France), Erland Erdmann (Germany), Ele Ferrannini (Italy), Allan Flyvbjerg (Denmark), Helmut Gohlke (Germany), Jose Ramon Gonzalez Juanatey (Spain), Ian Graham (Ireland), Pedro Filipe Monteiro (Portugal), Klaus Parhofer (Germany), Kalevi Pyörälä (Finland), Itamar Raz (Israel), Guntram Schernthaner (Austria), \Massimo Volpe (Italy), David Wood (UK)

  20. Heart failure and diabetes ESC and EASD Guidelines 2007

  21. Gaps of evidence Does any specific treatment of the following co-morbidities in patiens with HF reduce morbidity and mortality? • renal dysfunction • anaemia • diabetes • depression • disordered breathing during sleep

  22. Management of DM in patients with HF The recommendations in the ESC/EASD Guidelines for the management of DM apply to most patients with HF the following specific issues are of special interest • All patients should receive lifestyle recommendations. Class of recommendation I, level of evidence A • Elevated blood glucose should be treated with tight glycaemic control. Class of recommendation II, level of evidence A • Oral antidiabetic therapy should be individualized. Class of recommendation I, level of evidence B •Metformin should be considered as a first-line agent in over- weight patients with type II DM without significant renal dysfunction (GFR >30 mL/min). Class of recommendation II, level of evidence B

  23. Time to first major event (death, reinfarction, or stroke) DIGAMI2, EHJ, 2005, 26:656

  24. Death or nonfatal cardiac arrest CREATE-ECLA, JAMA, 2005, 293:441

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