Diabetes Impact on Myocardial Infarction Outcomes
Summary
People with diabetes who suffer a myocardial infarction face markedly worse outcomes than non-diabetic individuals. Diabetes doubles the risk of early mortality and sustains elevated rates of heart failure, recurrent infarction and stroke over the long term. Contributing mechanisms include chronic hyperglycaemia, which drives endothelial dysfunction, autonomic neuropathy and metabolic inflexibility, exacerbating ischaemia–reperfusion injury and microvascular obstruction. A pro-inflammatory state emerges as a key factor: elevated cytokine release and bone marrow activation impair resolution of injury and promote adverse ventricular remodelling. Diabetic cardiomyopathy and small-vessel disease further limit collateral perfusion and attenuate myocardial repair. These multifactorial vulnerabilities reduce the efficacy of standard reperfusion and pharmacotherapy, emphasising the need for enhanced prevention, vigilant glucose management and novel interventions. Given the global rise in both type 1 and type 2 diabetes, addressing these challenges is crucial to reducing the cardiovascular burden and improving survival and functional recovery after myocardial infarction.
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Diabetes Impact on Myocardial Infarction Outcomes publication trend
The graph below shows the total number of articles in diabetes impact on myocardial infarction outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Myocardial infarction (MI): Necrosis of cardiac muscle due to prolonged ischaemia following coronary artery occlusion.
Type 2 diabetes mellitus (T2DM): A chronic metabolic disorder characterised by insulin resistance, relative insulin deficiency and persistent hyperglycaemia.
Glucagon-like peptide-1 receptor agonist (GLP-1 RA): A class of antidiabetic agents that mimics incretin hormones to enhance insulin secretion and suppress glucagon release.
Sodium–glucose cotransporter-2 inhibitor (SGLT-2i): A pharmacological group that lowers blood glucose by preventing renal reabsorption of filtered glucose, with added cardiovascular benefits.
Inflammation: The coordinated immune response to tissue injury, involving cytokine secretion, leukocyte recruitment and processes of removal and repair.
References
- Emerging opportunities to target inflammation: myocardial infarction and type 2 diabetes. Cardiovascular Research (2024).
- Impact of chronic GLP-1 RA and SGLT-2I therapy on in-hospital outcome of diabetic patients with acute myocardial infarction. Cardiovascular Diabetology (2023).
- Diabetes mellitus duration and mortality in patients hospitalized with acute myocardial infarction. Cardiovascular Diabetology (2022).
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