How Diabetes and Heart Attacks Affect Long-Term Survival

---

Vaccaro O, Eberly LE, Neaton JD, et al.: Impact of diabetes and previous myocardial infarction on long-term survival. Arch Intern Med 164:1438-1443, 2004.

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

Experts think that preventing heart disease in patients with diabetes should be the same as the treatment doctors give people who don't have diabetes but have had a heart attack. It is unclear if the higher risk of heart disease in people with diabetes is the same as it is for people who don't have diabetes, but have had a heart attack.

The researchers wanted to compare the death rate in men who had diabetes or a heart attack. They studied age, heart disease, and the length of follow-up after a heart attack. The study group was large, so the researchers got detailed information on what contributed to people dieing.

Who was studied?

The researchers studied information stored in a database between 1973 and 1975. 4,809 men who took diabetes medication, but who had not had a heart attack were put into one group. The second group included 4,625 men who had had a heart attack but did not take diabetes medication. The men were between the ages of 35 and 57.

How was the study done?

The participants were grouped into two categories. One was by age; the other was by the number of risk factors (high blood pressure, cholesterol level, or current smoker). Death rates were then calculated for both groups.

What did the researchers find?

The researchers found that both diabetes and a previous heart attack are strong signals that people may die from heart disease. However, men with heart disease had a higher death rate from heart attacks than did those with diabetes only. Among men with diabetes, though, the death rate was higher from other causes, such as kidney failure, liver failure, and pneumonia.

What were the limitations of the study?

The study was limited by having no information on women. It also didn't include information on the type of diabetes, how long patients had had diabetes, and when patients were in the hospital for heart attacks.

What are the implications of the study?

Strong measures to prevent heart disease in people with diabetes are needed. Also, blood glucose control, watching for disease of small blood vessels, and careful treatment of infections for people with diabetes is very important.