新近诊断及先前已知的糖尿病和急性心肌梗死后1年结局:缬沙坦在急性心肌梗死中的应用试验(VALIANT)

作     者：Aguilar D. Solomon S.D. Koφber L. 郝广华 

作者机构：Cardiovascular Division Univ. of Texas Health Science Center MSB 1.246 6431 Fannin Houston TX 77030 United States Dr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第3期

页      面：26-27页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：急性心肌梗死 VALIANT 心血管事件 死亡风险 

摘      要：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 1.43; 95%confidence interval, 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.