Improving Care for People With Heart Disease and Diabetes

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Franklin K, Goldberg RJ, Spencer F, et al.: Implications of diabetes in patients with acute coronary syndromes. Arch Intern Med 164:1457–1463, 2004. 

What is the problem, and what is known about it so far?

People with diabetes are more likely to have a heart attack or heart failure and are more likely to die from a heart attack than people without diabetes. Even though the number of people without diabetes who have died from heart problems has decreased in the past several years, the number of patients with diabetes who died from heart problems has not.

The researchers wanted to know why there hasn't been a decrease in the number of people with diabetes dying from heart disease.

Who was studied?

A total of 16,116 patients who were hospitalized for heart problems between April 1999 and September 2001 were included in this study. The study used a database from the Global Registry of Acute Coronary Events. This database includes men and women—with and without diabetes -- of all ages from 14 countries around the world who have been hospitalized with heart problems.

How was the study done?

The researchers reviewed information -- including age, sex, history of heart disease, body mass index (BMI, a measure of weight related to height), smoking, and blood pressure -- from the database. They compared this information between patients with diabetes and patients without diabetes.

What did the researchers find?

Patients with diabetes who had heart disease were older, had a higher BMI and higher blood pressure, and were more likely to be women. However, patients with diabetes were less likely to be smokers and had lower cholesterol levels than the patients without diabetes.

The researchers do not believe that differences in age, BMI, and blood pressure levels alone explain the higher death rate among those with diabetes. They think patients with diabetes receive different medical treatment for their heart disease than patients without diabetes (like different medications or surgeries).

What were the limitations of the study?

One of the limitations of this study is that no information was available about how long these patients had diabetes or how severe their diabetes was. Also, the researchers did not have information on other possible lifestyle habits (like how much alcohol patients drank), and how that might affect the results of this study.

What are the implications of the study?

Patients with heart disease who also have diabetes have a higher risk of worse outcomes when in the hospital. They also get different care than people in the hospital without diabetes. The researchers believe that giving better medications and care for heart disease patients with diabetes would improve the medical outcomes for these patients.