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Growing impact of diabetes on acute MI hospitalizations, 1988 vs 2002

Growing impact of diabetes on acute MI hospitalizations, 1988 vs 2002. Diabetes. No diabetes. New York City hospital discharge records*. Hospitalizations. Hospital days. Patients with MI ( % , 1988–2002). *Statewide Planning and Research Cooperative System (SPARCS).

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Growing impact of diabetes on acute MI hospitalizations, 1988 vs 2002

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  1. Growing impact of diabetes on acute MI hospitalizations, 1988 vs 2002 Diabetes No diabetes New York City hospital discharge records* Hospitalizations Hospital days Patients with MI (% , 1988–2002) *Statewide Planning and Research Cooperative System (SPARCS) Fang J, Alderman M. Diabetes. 2006;55:768-73.

  2. IVUS shows greater atherosclerotic disease burden in diabetes Diabetes No diabetes N = 654 with CHD; 128 (19.6%) with diabetes P = 0.03 P = 0.01 P = 0.0002 % IVUS = intravascular ultrasound Nicholls SJ et al. J Am Coll Cardiol. 2006;47:1967-75.

  3. ADA: Physical activity recommendations in type 2 diabetes and IGT T2DM = type 2 diabetes IGT = impaired glucose tolerance Sigal RJ et al. Diabetes Care. 2006;29:1433-8.

  4. INVEST: Significant predictors of diabetes Reduced risk Increased risk Baseline Covariate HR 95% CI P Multiracial/other ethnicity 1.64 1.15–2.34 <0.01 US resident 1.62 1.37–1.91 <0.001 Left ventricular hypertrophy 1.27 1.10–1.46 <0.01 Prior stroke/TIA 1.26 1.03–1.58 0.03 Hispanic ethnicity 1.21 1.05–1.39 <0.01 Coronary revascularization 1.18 1.03–1.35 0.02 Hypercholesterolemia 1.17 1.04–1.31 0.01 BMI (5-kg/m2 increments) 1.05 1.04–1.06 <0.001 Age (10-yr increments) 0.90 0.85–0.96 <0.001 Strategy: verapamil SR (vs atenolol) 0.85 0.76–0.95 <0.01 0.5 1.0 1.5 2.0 2.5 HR (95% CI) TIA = transient ischemic attack Cooper-DeHoff R et al. Am J Cardiol. 2006;98:890-4.

  5. INVEST: Follow up systolic BP associated with new diabetes N = 16,176 with CAD + hypertension, without diabetes 12 1.8 1.6 10 1.4 1.2 8 Patients developing diabetes (%) Estimated hazard ratio 1.0 6 0.8 4 0.6 0.4 2 0.2 0 0 <120 120 to <130 130 to<140 140 to<150 ≥150 SBP (mm Hg) Hazard ratio (P < 0.001) Incidence (%) Cooper-DeHoff R et al. Am J Cardiol. 2006;98:890-4.

  6. Prevention of CV events with lipid lowering by diabetes status: Meta-analysis Diabetes No diabetes N = 80,862 with and without diabetes, 12 trials NNT Primary prevention Secondary prevention NNT = number needed to treat Costa J et al. BMJ. 2006;332:1115-24.

  7. HPS: Statin beneficial irrespective of baseline lipid level and diabetes status Heart Protection Study Event rate (%) Simvastatin n = 10,269 Placebo n = 10,267 Statin better Placebo better LDL-C <116 mg/dL With diabetes 15.7 20.9 No diabetes 18.8 22.9 LDL-C ≥116 mg/dL With diabetes 23.3 27.9 No diabetes 20.0 26.2 24% reductionP < 0.0001 All patients 19.8 25.2 0.4 0.6 0.8 1.0 1.2 1.4 Event rate ratio HPS Collaborative Group. Lancet. 2003;361:2005-16.

  8. CARDS: Statin reduces primary outcome N = 2838 with diabetes without CHD; LDL-C ≤160 mg/dL 15 RRR 37%(95% CI, 17%–52%) P = 0.001 Placebo127 events 10 Cumulativehazard(%) Atorvastatin83 events 5 0 0 1 2 3 4 4.75 Years Colhoun HM et al. Lancet. 2004;364:685-96.

  9. TNT diabetic analysis: Treatment effects on LDL-C Treatment to New Targets; N = 1501 with CHD and diabetes 160 Atorvastatin 10 mg 28% (21.6 mg/dL) P < 0.001 160.0 120 96.7 98.6 Mean LDL-C (mg/dL) 80 95.6 77.0 Atorvastatin 80 mg 40 0 Run-inPhase Baseline Final 5 years 8 weeks *Open-label treatment atorvastatin with 10 mg Shepherd J et al. Diabetes Care. 2006;29:1220-6.

  10. TNT diabetic analysis: First major CV event N = 1501 with CHD and diabetes 25 RRR 25% HR = 0.75 (95% CI 0.58–0.97) P = 0.026 Atorvastatin 10 mg 17.9% 20 Patients with major CV events* (%) 13.8% 15 Atorvastatin 80 mg 10 5 0 0 1 2 3 4 5 6 Years *CHD death, nonfatal non-procedural MI, resuscitated cardiac arrest, fatal/nonfatal stroke Shepherd J et al. Diabetes Care. 2006;29:1220-6.

  11. TNT: MetS increases CV risk regardless of diabetes status N = 10,001 with CHD 20 15 HR 2.24 (1.87–2.68)P < 0.0001 Patientswith major CV event (%) 10 5 HR 1.35 (1.16–1.56)P < 0.0001 0 0 1 2 3 4 5 6 Time to first major CV event (years) MetS + diabetes (n = 1231) MetS, no diabetes (n = 4353) No MetS + diabetes (n = 270) No MetS, no diabetes (n = 4147) MetS = metabolic syndrome Deedwania P et al. Lancet. 2006;368:919-28.

  12. AHA/ACC 2006 Secondary prevention guidelines: Risk factor modification in diabetes Smith SC et al. Circulation. 2006;113:2363-72.

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