Abstract 19414: Influence of Diabetes on Post-Myocardial Infarction Left Ventricular Remodeling and RAAS Inhibition with Aliskiren
Background: Diabetes mellitus (DM) is associated with worse outcomes following MI. We assessed the effect of DM on post-MI remodeling and whether DM modifies the effect of aliskiren on top of standard RAAS inhibition on remodeling and outcomes.
Methods: The ASPIRE trial enrolled 820 patients (pts) 2–8 weeks after acute MI with EF≤45% and randomly assigned them to the direct renin inhibitor aliskiren (n=423) or placebo (n =397) added to standard medical therapy. LV remodeling by echo was assessed after 26–36 weeks. We compared cardiac structure and function at baseline and follow-up in pts with evaluable paired echos (n=672), and risk of CV and adverse events among all randomized pts (n=820), by DM status and randomized treatment.
Results: The 214 (26%) pts with DM were older, more frequently hypertensive, and had more severe HF at presentation. Pts with and without DM had similar baseline EF (38±5 vs 38±5%, p=0.48) and end-systolic volume (ESV) (82±28 vs 84±25 ml, p=0.46) and experienced similar reductions in ESV at follow-up (−4.4±16.2 vs -3.9±16.7 ml, p=0.74). Despite this, DM pts were at higher risk than non-DM pts for a composite endpoint of CV death, HF hospitalization, recurrent MI, stroke, or aborted sudden death (14% versus 7%; age-adjusted HR 1.8, 95% CI 1.2–2.9; p=0.01). In post-hoc analyses, DM pts appeared to experience greater reduction in ESV (interaction P = 0.09) than non-DM pts and fewer clinical events (interaction P = 0.04) when treated with aliskiren (table). Among DM pts, aliskiren therapy was associated with numerically greater incidence of hyperkalemia (7 [7.3%] versus 1 [1.1%], p=0.07) and renal dysfunction (4 [4.2%] versus 1 [1.1%]), but not hypotension.
Conclusions: DM pts have increased risk post-MI without worse adverse remodeling or reduction in systolic function. These post-hoc hypothesis-generating findings also raise the possibility that DM pts may derive greater benefit from aliskiren on top of standard RAS inhibition therapy than pts without DM.
- © 2010 by American Heart Association, Inc.