Who is at Greater Risk for Heart Problems: Newly Diagnosed or Previously Diagnosed Patients With Diabetes?

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Aguilar D, Solomon SD, Kober L, et al.: Newly diagnosed and previously known diabetes mellitus and 1-year outcomes of acute myocardial infarction: The VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Circulation 110:1572-1578, 2004.

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

About 20% to 30% of people who have a heart attack also have diabetes. Patients with diabetes have a higher risk of death and other heart and blood vessel problems after they have a heart attack.

The researchers wanted to learn more about the risks of heart problems and death for people who are diagnosed with diabetes after they have a heart attack.

Who was studied?

The study looked at 14,703 patients from 29 countries involved in another study called Valsartan in Acute Myocardial Infarction, or VALIANT. The patients were men and women 18 years of age or older who had had a heart attack.

Participants were put into one of three groups: previously diagnosed diabetes, newly diagnosed diabetes, or no diabetes.

How was the study done?

The researchers measured the risk of each group for death and heart and blood vessel problems within 1 year after their heart attack.

The researchers also looked at blood tests and considered any medications the participants were taking.

What did the researchers find?

People with newly diagnosed and previously diagnosed diabetes were more likely to die than patients without diabetes. One year after their heart attacks, 602 patients with previously diagnosed diabetes (17.7%), 94 patients with newly diagnosed diabetes (16.2%), and 1,169 patients without diabetes (10.9%) had died.

Also, all patients with diabetes had higher rates of heart and blood vessel problems than those without diabetes.

The risks of death and major heart and blood vessel problems were similar for every patient with diabetes. This was true even though at the beginning of the study the newly diagnosed patients were more like the patients without diabetes.

What were the limitations of the study?

Blood glucose levels were not tracked. It is possible that blood glucose is connected to poor health effects. Also, the study was limited to those high-risk patients who met the requirements for entry into the VALIANT trial.

What are the implications of the study?

Even though it is difficult for doctors to make a diagnosis of diabetes soon after a heart attack, it is important to test for diabetes. Doing this will help identify patients who are at high risk for other health problems and who need more treatment to lower their risk.