TY - JOUR
T1 - Association between diabetes mellitus and angina after acute myocardial infarction
T2 - Analysis of the TRIUMPH prospective cohort study
AU - Arnold, Suzanne V.
AU - Spertus, John A.
AU - Lipska, Kasia J.
AU - Tang, Fengming
AU - Goyal, Abhinav
AU - McGuire, Darren K.
AU - Cresci, Sharon
AU - Maddox, Thomas M.
AU - Kosiborod, Mikhail
N1 - Funding Information:
TRIUMPH was supported by the National Institutes of Health (National Heart, Lung, Blood Institute): SCCOR grant no. P50HL077113-01. This work was supported by an investigator-initiated research grant from Gilead Sciences, Foster City, CA, USA. Dr. Cresci's is supported in part by the National Institutes of Health (Cresci R01 NR013396).
Publisher Copyright:
© 2014 The European Society of Cardiology.
PY - 2015/6/11
Y1 - 2015/6/11
N2 - Aims: While patients with diabetes mellitus (DM) have more extensive coronary disease and worse survival after acute myocardial infarction (AMI) than patients without DM, data on whether they experience more angina are conflicting. Methods:We examined angina prevalence over the year following AMI among 3367 patients, including 1080 (32%) with DM, from 24 US hospitals enrolled in the TRIUMPH registry from 2005 to 2008. Results: Patients with vs. without DM were more likely to be treated with antianginal medications both at discharge and over follow up. Despite more aggressive angina therapy, patients with vs. without DM had higher prevalence and severity of angina prior to AMI (49 vs. 43%, p=0.001) and at each follow-up assessment, although rates of angina declined in both groups over time. In a hierarchical, multivariable, repeated-measures model that adjusted for multiple demographic and clinical factors including severity of coronary disease and in-hospital revascularization, DM was associated with a greater odds of angina over the 12 months of follow up; this association increased in magnitude over time (12-month OR 1.18, 95% CI 1.01-1.37; DM∗time pinteraction=0.008). Conclusions: Contrary to conventional wisdom, angina is more prevalent and more severe among patients with DM, both prior to and following AMI. This effect is amplified over time and independent of patient and treatment factors, including the presence of multivessel disease and coronary revascularization. This increased burden of angina may be due to more diffuse nature of coronary disease, more rapid progression of coronary disease over time, or greater myocardial demand among DM patients.
AB - Aims: While patients with diabetes mellitus (DM) have more extensive coronary disease and worse survival after acute myocardial infarction (AMI) than patients without DM, data on whether they experience more angina are conflicting. Methods:We examined angina prevalence over the year following AMI among 3367 patients, including 1080 (32%) with DM, from 24 US hospitals enrolled in the TRIUMPH registry from 2005 to 2008. Results: Patients with vs. without DM were more likely to be treated with antianginal medications both at discharge and over follow up. Despite more aggressive angina therapy, patients with vs. without DM had higher prevalence and severity of angina prior to AMI (49 vs. 43%, p=0.001) and at each follow-up assessment, although rates of angina declined in both groups over time. In a hierarchical, multivariable, repeated-measures model that adjusted for multiple demographic and clinical factors including severity of coronary disease and in-hospital revascularization, DM was associated with a greater odds of angina over the 12 months of follow up; this association increased in magnitude over time (12-month OR 1.18, 95% CI 1.01-1.37; DM∗time pinteraction=0.008). Conclusions: Contrary to conventional wisdom, angina is more prevalent and more severe among patients with DM, both prior to and following AMI. This effect is amplified over time and independent of patient and treatment factors, including the presence of multivessel disease and coronary revascularization. This increased burden of angina may be due to more diffuse nature of coronary disease, more rapid progression of coronary disease over time, or greater myocardial demand among DM patients.
KW - Angina
KW - diabetes mellitus
KW - myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=84929079726&partnerID=8YFLogxK
U2 - 10.1177/2047487314533622
DO - 10.1177/2047487314533622
M3 - Article
C2 - 24740679
AN - SCOPUS:84929079726
SN - 2047-4873
VL - 22
SP - 779
EP - 787
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 6
ER -