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Diabetes and Mortality Risk After Acute Coronary Syndromes
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To the Editor: Dr Donahoe and colleagues1 concluded that "despite modern therapies for ACS, diabetes conferred a significant independent excess mortality risk at 30 days and 1 year following ACS. Current strategies are insufficient to ameliorate the adverse impact of diabetes." This conclusion was based on their analysis that found that patients with diabetes have higher risk of mortality compared with patients without diabetes after adjusting for treatment for ACS and discharge medications in a logistic regression model. However, treating a variable such as medications on discharge as a confounder and adjusting for it in a regression model can produce misleading results if an interaction is present.2-3
It is reasonable to postulate that an interaction exists between therapies for ACS and diabetes based on previous studies. For example, treatment with lisinopril after a myocardial infarction reduced mortality in patients with and without diabetes. However, the reduction in mortality was much . . . [Full Text of this Article]
Kapil Parakh, MD, MPH
kparakh1@jhmi.edu
Johns Hopkins University School of Medicine
Baltimore, Maryland
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