Krzysztof Strojek1, Itamar Raz1, György Jermendy1, Anselm K Gitt1, Rong Liu1, Qianyi Zhang1, Scott J Jacober1, Zvonko Milicevic1. 1. Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria.
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. MAIN OUTCOME MEASURES: The primary objective was to identify demographic, glycemic, and CV risk 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 in mean 2-hour blood glucose level after meals was associated with the greatest difference in event-free survival probability for the primary end point: mean time 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 event-free survival. CONCLUSIONS: Postprandial glycemia should be considered a potential target in trials to reduce CV morbidity and mortality in type 2 diabetes mellitus.
RCT Entities:
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. MAIN OUTCOME MEASURES: The primary objective was to identify demographic, glycemic, and CV risk 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 in mean 2-hour blood glucose level after meals was associated with the greatest difference in event-free survival probability for the primary end point: mean time 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 event-free survival. CONCLUSIONS: Postprandial glycemia should be considered a potential target in trials to reduce CV morbidity and mortality in type 2 diabetes mellitus.
Authors: Tien F Lee; Morton G Burt; Leonie K Heilbronn; Arduino A Mangoni; Vincent W Wong; Mark McLean; N Wah Cheung Journal: Cardiovasc Diabetol Date: 2017-12-12 Impact factor: 9.951