Abstract
Survivors after a myocardial infarction (MI), especially those with diabetes mellitus (DM), remain at high risk of further events. Identifying and treating factors that may influence survival may open new therapeutic strategies. We assessed the impact on prognosis of DM and hypovitaminosis D (hypovitD), alone or combined. In this prospective, observational study, 1081 patients were enrolled surviving an MI and divided into four groups according to their diabetic and VitD status. The primary end-point was composite of all-cause mortality, angina/MI and heart failure (HF). Secondary outcomes were mortality, HF and angina/MI. During a follow-up of 26.1 months (IQR 6.6–64.5), 391 subjects experienced the primary end-point. Patients with DM or hypovitD had similar rate of the composite end-point. Patients with only hypovitD or DM did not differ regarding components of composite end-point (angina p = 0.97, HF p = 0.29, mortality p = 0.62). DM and VitD deficiency had similarly adjusted risks for primary end-point (HR 1.3, 95%CI 1.05–1.61; HR 1.3, 95% CI 1.04–1.64). The adjusted HR for primary composite end-point for patients with hypovitD and DM was 1.69 (95%CI 1.25–2.29, p = 0.001) in comparison to patients with neither hypoD nor DM. In conclusion, DM and hypovitD, individually and synergistically, are associated with a worse outcome after MI.
Highlights
Cardiovascular diseases and diabetes mellitus (DM) are two important burdens on health worldwide and their prevalence is predicted to continue to rise if current trends prevail [1]
Mortality caused by myocardial infarction (MI) is declining, survivors after MI, especially those with DM, remain at high risk of further cardiovascular events [3]
One third of the population (361 patients; 33.4%) were diabetic: 315 patients (29.1%) were diagnosed with DM before admission, while in 46 patients (4.2%) the diagnosis of DM was made during the index hospitalization
Summary
Cardiovascular diseases and diabetes mellitus (DM) are two important burdens on health worldwide and their prevalence is predicted to continue to rise if current trends prevail [1]. Vitamin D (VitD) deficiency, a worldwide health problem, emerged in the last years as a cardiovascular risk factor, being associated with the development of coronary atherosclerosis [5] and with a worse prognosis of patients surviving MI [6,7]. VitD deficiency is common in DM [8] and diabetic patients with complications have lower levels of serum VitD, compared to those without any [9,10]. In patients with MI, VitD deficiency is associated with poorly controlled glucose homeostasis through increased insulin resistance and decreased insulin secretion [11]. The evaluation of additional hazards associated with insufficient VitD levels and DM among patients surviving MI could provide important indication for the clinical practice management. We assessed the prognostic impact of DM and insufficient levels of VitD, alone or in combination, in patients with previous MI
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