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

T. M. MacDonald*, R. Butler, R. W. Newton, A. D. Morris

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)282-289
Number of pages8
JournalDiabetic Medicine
Volume15
Issue number4
DOIs
Publication statusPublished - 27 Apr 1998

Keywords

  • ACE inhibitors
  • Aspirin
  • Beta- blockers
  • Diabetes
  • MEMO
  • Myocardial infarction
  • Secondary prevention
  • Statins

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