2017

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2017/№4

The frequency and timing of acute myocardial infarction onset in patients with type 2 diabetes, depending on the glucose-lowering therapy

Kakorin S. V.1, Averkova I. A.2, Mkrtumyan A. M.2, Melkonyеn G. G.1
1 – Municipal Hospital #4 of the Moscow Health Care Department, Pavlovskaya 25, Moscow 115093
2 – A. I. Evdokimov Moscow State University for Medicine and Dentistry, Delegatskaya 20, Bld. 1, Moscow 127473

Keywords: diabetes mellitus, blood glucose lowering therapy, acute myocardial infarction, chronic heart failure, chronic kidney disease

DOI: 10.18087/rhj.2017.4.2372

Aim. To assess the frequency and terms of AMI occurrence in patients with type 2 DM depending on blood glucose lowering therapy preceding current hospitalization as well as to characterize AMI epidemiology in dependence to CHF functional class and CKD stage. Materials and methods. We analyzed medical records of 6138 patients, discharged in 2010–2016 years from cardiology departments of hospitals in Moscow City – Hospitals № 63 and № 4 (2010-2013), 2434 – from Hospital № 4 (2014-2016). Results. The interval between type 2 DM diagnosis and first AMI incidence depended on blood glucose lowering therapy type and CKD stage. Greater interval from type 2 DM diagnosis to AMI incidence in type 2 DM patients in 2014–2016, compared to 2010–2013 was caused by more frequent indication of statins, ATF inhibitors. The term between DM2 diagnosis an AMI incidence in patients, receiving insulin, was 15.5–18.1 years 2‑nd generation sulfonilureas drugs 6.0–9.5; biguanides – 5.7–6.0 years. Comparison of type 2 DM patients number hospitalized in 2010–2013 and in 2014–2016 showed that the number of patients receiving biguanides monotherapy increased from 6.9 % to15.6 %; sulfonureas monotherapy – decreased from 31.9% to 25.6%. Monotherapy by insulin was indicated to 14.5% in 2010–2013 and to 16,1% in 2014–2016 (difference not significant, p<0.05). The patients hospitalized with CHF II–III FC and CKD II–IV stages on combined therapy including sulfonilureas drugs of 2‑nd generation and biguanides had a later occurrence of of AMI in comparison to sulfonilureas monotherapy. Risk ratio for AMI occurrence between groups of patients with CHF of IV FC, receiving insulin and biguanides (2010-2013) was 2.5:1 (17.6% and 7.1% respectively), and in patients with CHF I FC it was 0,6:1 (8.8% and 14.3%). Conclusion. Glucose-lowering therapy as well as the use of statins and ATF inhibitors influences the prognosis of AMI occurrence in patients with ICD under different CHF functional classes and CKD stages.
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Kakorin S. V., Averkova I. A., Mkrtumyan A. M., Melkonyеn G. G. The frequency and timing of acute myocardial infarction onset in patients with type 2 diabetes, depending on the glucose-lowering therapy. Russian Heart Journal. 2017;16(4):260–267

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