Which drugs benefit diabetic patients for secondary prevention of myocardial infarction?

TY - JOUR

T1 - Which drugs benefit diabetic patients for secondary prevention of myocardial infarction?

AU - MacDonald, T. M.

AU - Butler, R.

AU - Newton, R. W.

AU - Morris, A. D.

PY - 1998/4/27

Y1 - 1998/4/27

N2 - Diabetic patients have increased mortality following myocardial infarction. We review the evidence for benefit in diabetic patients, of the major drug groups used as secondary prevention. Beta blockers: meta-analyses suggest a reduction in mortality of 35% with beta blockers. Diabetic patients should receive beta blockers post myocardial infarction. In many patients, the benefits of beta blockers will outweigh relative contraindications. Aspirin: meta-analyses of antiplatelet therapy in high-risk subjects have shown substantial benefits. Aspirin should be prescribed for secondary prevention. Lipid lowering with statins: subgroup analyses of the major secondary prevention trials show substantial benefits across a wide range of baseline cholesterol and LDL levels. These drugs should be prescribed as secondary prevention to patients with diabetes whose total cholesterol is > 4.0 mmol-1. Angiotensin converting enzyme inhibitors (ACEIs): the few subgroup analyses that exist from ACEI trials suggest that diabetic and non- diabetic patients derive similar benefits. Diabetic subjects who have systolic dysfunction after myocardial infarction should receive ACEIs. Treatment combination: data exist to suggest that most of these drugs produce benefit independently. Conclusion: diabetic patients benefit from secondary prevention with drug treatment as much as, or more than, non-diabetic patients.

AB - Diabetic patients have increased mortality following myocardial infarction. We review the evidence for benefit in diabetic patients, of the major drug groups used as secondary prevention. Beta blockers: meta-analyses suggest a reduction in mortality of 35% with beta blockers. Diabetic patients should receive beta blockers post myocardial infarction. In many patients, the benefits of beta blockers will outweigh relative contraindications. Aspirin: meta-analyses of antiplatelet therapy in high-risk subjects have shown substantial benefits. Aspirin should be prescribed for secondary prevention. Lipid lowering with statins: subgroup analyses of the major secondary prevention trials show substantial benefits across a wide range of baseline cholesterol and LDL levels. These drugs should be prescribed as secondary prevention to patients with diabetes whose total cholesterol is > 4.0 mmol-1. Angiotensin converting enzyme inhibitors (ACEIs): the few subgroup analyses that exist from ACEI trials suggest that diabetic and non- diabetic patients derive similar benefits. Diabetic subjects who have systolic dysfunction after myocardial infarction should receive ACEIs. Treatment combination: data exist to suggest that most of these drugs produce benefit independently. Conclusion: diabetic patients benefit from secondary prevention with drug treatment as much as, or more than, non-diabetic patients.

KW - ACE inhibitors

KW - Aspirin

KW - Beta- blockers

KW - Diabetes

KW - MEMO

KW - Myocardial infarction

KW - Secondary prevention

KW - Statins

U2 - 10.1002/(SICI)1096-9136(199804)15:4<282::AID-DIA591>3.0.CO;2-C

DO - 10.1002/(SICI)1096-9136(199804)15:4<282::AID-DIA591>3.0.CO;2-C

M3 - Review article

C2 - 9585392

AN - SCOPUS:0031961241

SN - 0742-3071

VL - 15

SP - 282

EP - 289

JO - Diabetic Medicine

JF - Diabetic Medicine

IS - 4

ER -