Factors associated with cardiovascular events in patients with type 2 diabetes and acute myocardial infarction

Abstract

Context: Decreasing risk of cardiovascular (CV) disease remains a challenge to survival in type 2 diabetes. Objective: The objective was to assess the association between demographic, glycemic, and other clinical factors and CV risk in the Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus trial. Design, Settings, Participants, and Intervention: We used discrete-time survival tree analysis to examine data collected for up to 4.6 years in 1115 patients with type 2 diabetes mellitus experiencing acute myocardial infarction (MI) less than or equal to 18 days before enrollment. MainOutcomeMeasures:The primary objectivewasto identify demographic, glycemic,andCVrisk factors best separating survival curves over time for a composite end point: CV death, nonfatal MI, nonfatal stroke, hospitalization for acute coronary syndromes, or coronary revascularization planned after randomization. Results: Average change across visits inmean2-hour blood glucose level after meals was associated with the greatest difference in event-free survival probability for the primary end point:meantime to 75% event-free survival for an average change across visits less than or equal to -0.14 mmol/L, 73.48 weeks; for visits with average change more -0.14 mmol/L, 29.10 weeks. An average change across visits in the hemoglobin A1c level less than or equal to -0.92% (-10.06 mmol/mol) and the absence of a history of stroke or acute MI increased CV event-free survival time further. Fasting blood glucose and randomized insulin treatment strategy were weak predicting factors of eventfree survival. Conclusions: Postprandial glycemia should be considered a potential target in trials to reduce CV morbidity and mortality in type 2 diabetes mellitus.