Secondary Prevention Measures after Acute Myocardial Infarction: Comparison between Diabetics and Non-Diabetics at a Saudi Teaching Hospital

Objective: To compare between the use of secondary prevention measures after acute myocardial infarction in diabetic and non-diabetic patients who were admitted to the King Abdulaziz University Hospital. Method: All patients admitted with a definitive diagnosis of acute myocardial infarction between January 1995 and December 1999 were studied. Patients’ age, sex, body mass index, development of heart failure, peak serum creatinine phosphokinase, duration of hospital stay, use of aspirin, beta-blockers or angiotensin-converting enzyme (ACE) inhibitors on discharge and outcome were reported. Results: A total of 184 patients were studied, 53% were diabetics and 47% non-diabetics. The mean age for diabetics was 56 years with a male:female ratio of 3.9:1, while for non-diabetics it was 53 years with a male:female ratio of 7.7:1 (p = 0.05, p = 0.09, respectively). Diabetic patients had a higher incidence of heart failure compared to non-diabetics, 57 versus 43% (p = 0.05), and had a longer hospital stay, 12 versus 10 days (p = 0.03). Aspirin was used by 97% of the diabetics and 94% of the non-diabetics (p = 0.4), while beta-blockers were used by 43 and 44% (p = 0.9) and ACE inhibitors by 67 and 51% (p = 0.03), respectively. Conclusion: There is no difference in the use of aspirin and beta-blockers between diabetic and non-diabetic patients. ACE inhibitors were used more by diabetics. There is underutilization of beta-blockers by diabetics and non-diabetics. Physicians should be encouraged to use beta-blockers as secondary prevention measures after acute myocardial infarction as they have substantial benefits and are of generally low treatment cost.