Diabetes Is Associated With Worse Long-term Outcomes in Young Adults After Myocardial Infarction: The Partners YOUNG-MI Registry

Abstract

Objective: We sought to determine the prevalence of diabetes and associated cardiovascular outcomes in a contemporary cohort of young individuals presenting with their first myocardial infarction (MI) at age ≤50 years.

Research design and methods: We retrospectively analyzed records of patients presenting with a first type 1 MI at age ≤50 years from 2000 to 2016. Diabetes was defined as a hemoglobin A_1c ≥6.5% (48 mmol/mol) or a documented diagnosis of or treatment for diabetes. Vital status was ascertained for all patients, and cause of death was adjudicated.

Results: Among 2,097 young patients who had a type 1 MI (mean age 44.0 ± 5.1 years, 19.3% female, 73% white), diabetes was present in 416 (20%), of whom 172 (41%) were receiving insulin. Over a median follow-up of 11.2 years (interquartile range 7.3-14.2 years), diabetes was associated with a higher all-cause mortality (hazard ratio 2.30; P < 0.001) and cardiovascular mortality (2.68; P < 0.001). These associations persisted after adjusting for baseline covariates (all-cause mortality: 1.65; P = 0.008; cardiovascular mortality: 2.10; P = 0.004).

Conclusions: Diabetes was present in 20% of patients who presented with their first MI at age ≤50 years and was associated with worse long-term all-cause and cardiovascular mortality. These findings highlight the need for implementing more aggressive therapies aimed at preventing future adverse cardiovascular events in this population.

Figure 1

Cumulative hazard of all-cause and cardiovascular mortality according to diagnosis of diabetes. A: Kaplan-Meier curves of all-cause mortality in patients without diabetes, with diabetes not receiving insulin, and with diabetes receiving insulin. B: Kaplan-Meier curves of cardiovascular mortality in patients without diabetes, with diabetes not receiving insulin, and with diabetes receiving insulin.

Figure 2

Cumulative hazard of heart failure (HF) admission according to diagnosis of diabetes. Kaplan-Meier curves of heart failure admission 1 year post-MI in patients without diabetes, with diabetes not requiring insulin, and with diabetes requiring insulin.