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To the Editor: In their study of diabetes and mortality following acute coronary syndromes (ACS), Dr Donahoe and colleagues¹ reported higher mortality in patients at 30 days and 1 year after ACS by performing subgroup analysis on pooled data from 11 independent Thrombolysis in Myocardial Infarction (TIMI) trials. The authors state that mortality remains high despite available modern evidence-based treatment. However, the data presented show that proven and available measures for secondary prevention remain underused. Adverse clinical outcomes and underuse of secondary prevention strategies have been reported to be associated with worse clinical outcomes in patients with diabetes presenting with ACS.^2-3

In the study by Donahoe et al, hypolipidemic therapy was used at hospital discharge in 63.5% of patients with diabetes compared with 63.7% of patients without diabetes (P = .84). The CURE study⁴ showed that dual antiplatelet therapy with 3 to 12 months of thienopyridines such as clopidogrel added . . . [Full Text of this Article]

Manivannan Srinivasan, MBBS, MRCP
srinivasan.manivannan@mayo.edu

Sumit Bhagra, MBBS
Mayo Clinic
Rochester, Minnesota

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