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Diabetes association with self-reported health, resource utilization, and prognosis post-myocardial infarction.

ABSTRACT: Background: Diabetes mellitus (DM) is associated with increased cardiovascular (CV) risk. We compared health-related quality of life (HRQoL), healthcare resource utilization (HRU), and clinical outcomes of stable post-myocardial infarction (MI) patients with and without DM.

Hypothesis: In post-MI patients, DM is associated with worse HRQoL, increased HRU, and worse clinical outcomes.

Methods: The prospective, observational long-term risk, clinical management, and healthcare Resource utilization of stable coronary artery disease study obtained data from 8968 patients aged ?50?years 1 to 3?years post-MI (369 centers; 25 countries). Patients with ?1 of the following risk factors were included: age??65?years, history of a second MI >1 year before enrollment, multivessel coronary artery disease, creatinine clearance??15 and?<60?mL/min, and DM treated with medication. Self-reported health status was assessed at baseline, 1 and 2?years and converted to EQ-5D scores. The main outcome measures were baseline HRQoL and HRU during follow-up.

Results: DM at enrollment was 33% (2959 patients, 869 insulin treated). Mean baseline EQ-5D score (0.86 vs 0.82; P?
Conclusions: Stable post-MI patients with DM (especially insulin treated) had poorer EQ-5D scores, higher hospitalization rates and LoS, and worse clinical outcomes vs those without DM. Strategies focusing specifically on this high-risk population should be developed to improve outcomes.

Trial registration: ClinicalTrials.gov: NCT01866904 (https://clinicaltrials.gov).

SUBMITTER: Nicolau JC

PROVIDER: S-EPMC7724227 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Diabetes association with self-reported health, resource utilization, and prognosis post-myocardial infarction.

Nicolau José C JC Brieger David D Owen Ruth R Furtado Remo H M RHM Goodman Shaun G SG Cohen Mauricio G MG Simon Tabassome T Westermann Dirk D Granger Christopher B CB Grieve Richard R Yasuda Satoshi S Chen Jiyan J Hedman Katarina K Mellström Carl C Brandrup-Wognsen Gunnar G Pocock Stuart J SJ

Clinical cardiology 20201104 12

<h4>Background</h4>Diabetes mellitus (DM) is associated with increased cardiovascular (CV) risk. We compared health-related quality of life (HRQoL), healthcare resource utilization (HRU), and clinical outcomes of stable post-myocardial infarction (MI) patients with and without DM.<h4>Hypothesis</h4>In post-MI patients, DM is associated with worse HRQoL, increased HRU, and worse clinical outcomes.<h4>Methods</h4>The prospective, observational long-term risk, clinical management, and healthcare Re ...[more]

PMID: 33146924

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Project description:AIMS:Sarcolipin (SLN) is a key regulator of sarcoplasmic reticulum calcium-ATPase (SERCA)2a, which handles intracellular calcium re-uptake. This study was aimed to investigate the involvement of SLN in post-myocardial infarction (MI) heart failure (HF) in diabetes. METHODS AND RESULTS:Diabetes/MI rat models were established. Altered SLN expression in diabetic hearts was screened out by microarray. A myocardiotropic viral vector was used to deliver siRNA to silence SLN. DNA methylation was evaluated by bisulfite sequencing. Cardiac functions were evaluated by invasive haemodynamic examinations. The SERCA2a activity, cytoplasmic calcium concentration ([Ca2+ ]i ), calcium spark, and myocyte contraction were detected. Correlation between HF and diabetes was analysed in a cohort consisted of 101 ST-segment elevated myocardial infarction (STEMI) patients between 2017 and 2019 [53.54 ± 4.64 years old; 61.4% male gender; HbA1c% 6.15 ± 2.00; and left ventricular ejection fraction (LVEF%) 40.64 ± 3.20%]. SLN expression was evaluated in left ventricular tissue sample from six STEMI patients complicated with diabetes and six STEMI patients without diabetes. Expressions of DNA methyltransferase 1a and DNA methyltransferase 3 were reduced in diabetic hearts, leading to down-regulation of SLN promoter methylation, resulting in increased SLN expression in rats. Impaired heart systolic functions were found in experimental diabetic MI rats, which were attenuated by SLN silencing. SERCA2a activity reduction and [Ca2+ ]i elevation were attenuated by SLN silencing in diabetic animal hearts and high-glucose incubated primary myocytes. SLN silencing suppressed calcium sparks and improved contraction and sarcoplasmic reticulum calcium re-uptake in high-glucose incubated primary myocytes. Expression of SLN was up-regulated in LV sampled from STEMI patients complicated with diabetes compared with non-diabetic ones (P < 0.05). LVEF% was reduced in STEMI patients complicated with diabetes compared with non-diabetic ones (P < 0.01). HbA1c% and LVEF% was related (r = -0.218, P = 0.028). Increased HbA1c% was correlated with reduced LVEF% after adjustment for age, sex, body mass index, cigarette smoking, creatinine, UA, low density lipoprotein, K+ , Na+ , and troponin I (adjusted odds ration = 0.75, 95% confidence interval 0.62-0.90, P = 0.002). CONCLUSIONS:Diabetes increases the vulnerability of STEMI patients to post-MI HF by down-regulating SLN promoter methylation, which further regulates SERCA2a activity via increasing cardiac SLN expression.

Dataset Information

Diabetes association with self-reported health, resource utilization, and prognosis post-myocardial infarction.

Publications

Diabetes association with self-reported health, resource utilization, and prognosis post-myocardial infarction.

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