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For patients with acute coronary syndromes (ACS), diabetes mellitus (DM), but not pre-DM, is associated with an increased risk of major adverse cardiac events (MACE), according to a study published online Oct. 18 in the Journal of the American College of Cardiology. Serdar Farhan, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues examined the impact of pre-DM on coronary plaque characteristics and ischemic outcome in patients with ACS. Participants underwent quantitative coronary angiography, grayscale intravascular ultrasound (IVUS), and radiofrequency IVUS after successful percutaneous coronary intervention. Patients were categorized based on their glucometabolic status as normal glucose metabolism (NGM; 162 patients), pre-DM (202 patients), and DM (183 patients). The researchers found that there were no significant between-group differences with respect to IVUS findings indicative of vulnerable plaques. Compared to patients with pre-DM or NGM, patients with DM had a higher crude rate of MACE (25.9 versus 16.3 and 16.1 percent; P = 0.03 and 0.02, respectively). Using NGM as the reference group, DM, but not pre-DM, was correlated with increased risk of MACE in an adjusted model (hazard ratios, 2.2 [95 percent confidence interval, 1.25 to 3.86; P = 0.006] and 1.29 [95 percent confidence interval, 0.71 to 2.33; P = 0.41]).

Intensive blood pressure lowering may similarly decrease cardiovascular events in both patients with and patients without type 2 diabetes mellitus, according to a study published online Dec. 6 in Diabetes Care. Tom F. Brouwer, M.D., from the University of Amsterdam, and colleagues assessed the effect of both type 2 diabetes and baseline cardiovascular disease risk on the treatment effect of intensive blood pressure lowering based on data and pooled analysis from two randomized trials (ACCORD-BP [Action to Control Cardiovascular Risk in Diabetes Blood Pressure]and SPRINT [Systolic Blood Pressure Intervention Trial] studies; total of 14,094 patients). The researchers found that the mean baseline systolic blood pressure was 139.5 mm Hg for the cohort and just over one-third (33.6 percent) had type 2 diabetes. The hazard ratio for the primary composite end point of unstable angina, myocardial infarction, acute heart failure, stroke, and cardiovascular death was 0.82 (P = 0.0017). There was a nonsignificant interaction between intensive blood pressure lowering and type 2 diabetes (P = 0.13). While the 10-year cardiovascular risk was higher in patients with type 2 diabetes, there was no interaction between the risk and treatment effect (P = 0.84).

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