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Effect of diabetes mellitus and its treatment on ventricular arrhythmias complicating acute myocardial infarction
Author(s) -
Rana J. S.,
Mukamal K. J.,
Nesto R. W.,
Morgan J. P.,
Muller J. E.,
Mittleman M. A.
Publication year - 2005
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2005.01468.x
Subject(s) - medicine , diabetes mellitus , myocardial infarction , cardiology , heart failure , odds ratio , insulin , logistic regression , endocrinology
Aims To evaluate the effect of diabetes mellitus and its treatment on the risk of arrhythmias among early survivors of acute myocardial infarction. Research design and method The Onset Study was conducted in 64 US medical centres. Between August 1989 and September 1996, 3882 patients were interviewed after having an acute myocardial infarction. We used logistic regression models to examine the association of diabetes and its treatment with the risk of ventricular arrhythmia after adjustment for age, gender, hypertension, thrombolytic therapy, smoking, obesity, cardiac medicines and congestive heart failure. Results During the index hospitalization, patients with diabetes ( n = 814) were less likely to develop ventricular arrhythmias than patients without diabetes (6.8 vs. 13.3%, P < 0.001). The risk of ventricular arrhythmia in patients treated with first generation sulphonylureas or diet alone was similar to patients without diabetes (OR = 0.91; 95% CI, 0.39–2.15, and 0.76; 95% CI, 0.46–1.26, respectively). However, compared with patients without diabetes, the adjusted odds ratio (OR) for ventricular arrhythmias was lower among patients treated with insulin or patients treated with second generation sulphonylureas (OR = 0.54, 95% CI 0.32–0.92; OR = 0.45, 95% CI 0.27–0.75, respectively). Conclusions Compared with patients without diabetes, the risk of ventricular arrhythmias complicating acute myocardial infarction is lower in patients with diabetes treated with second generation sulphonylureas or insulin, but not in those treated with first generation sulphonylureas or diet alone. This suggests that differences in the mechanism of action of different sulphonylureas may result in clinically relevant differences in arrhythmic risk.