Mortality after myocardial infarction in patients with diabetes mellitus

See article on page 1577Diabetes mellitus (diabetes), in particular type 2 diabetes, constitutes one of the largest emerging threats to health in the 21st century. It is estimated that by 2030 as many as 360 million people world wide will be affected.¹The cause of death in those with diabetes is dominated by coronary heart disease, accompanied by increased rates of stroke and peripheral vascular disease: so called macrovascular complications. At least two‐thirds of deaths are attributable to these cardiovascular diseases and their sequelae.² A true picture of the extent of macrovascular complications is obscured, however, by inaccurate death certification³ and diagnostic criteria⁴ based on the development of microvascular complications (retinopathy, neuropathy, nephropathy). The Euro Heart⁵ Survey demonstrated that if one applied oral glucose tolerance tests to those presenting with all forms of acute coronary syndrome, two‐thirds display impaired glucose regulation.In the USA, although the overall mortality rate associated with coronary heart disease has declined over the past 20 years, this trend has not been reflected in a decline of mortality rates in patients with diabetes.⁶ Results published in this issue of Heart from the Swedish registry on coronary care (RIKS‐HIA) confirm this trend (see article on page 1577).⁷ After a myocardial infarction (MI), patients with diabetes had an increased mortality rate compared with non‐diabetic patients. Moreover, despite the existence of treatments which may benefit diabetic patients disproportionately, the relative hazard of mortality in diabetic patients has improved little compared with non‐diabetic patients between the time periods 1995–8 and 1999–2002. These observations give us a glimpse of the vast epidemic that is approaching, if not upon us.