Diabetes Phenotypes in Patients Presenting a Myocardial Infarction: Progress Towards Precision Medicine?

Area of Science:

• Cardiology
• Endocrinology
• Metabolic Diseases

Background:

• Traditional type 2 diabetes classification and management lack personalization.
• Myocardial infarction (MI) in diabetic patients requires better risk stratification.
• Understanding diabetes phenotypes at MI is crucial for personalized care.

Purpose of the Study:

• To identify distinct patient profiles of type 2 diabetes (T2D) at the time of myocardial infarction (MI).
• To assess 1-year cardiovascular event-free survival based on identified T2D profiles.
• To determine predictors of cardiovascular events in T2D patients experiencing MI.

Main Methods:

• Retrospective study of 250 T2D patients admitted for MI.
• K-means cluster analysis using age at diagnosis, BMI, HbA1c, GAD antibodies, insulin resistance, and beta-cell function.
• Cox multivariate models to identify predictors of 1-year cardiovascular and major adverse cardiovascular events.

Main Results:

• Identified five T2D profiles: severe insulin-deficient (46%), severe insulin-resistant (3%), mild obesity-related (16%), mild age-related (33%), and severe autoimmune (2%).
• Severe insulin-deficient and mild age-related diabetes were frequent phenotypes at MI.
• Higher glomerular filtration rate was the sole independent predictor of longer cardiovascular event-free survival (HR 0.97) and MACE-free survival (HR 0.98).

Conclusions:

• Distinct T2D pathophysiological phenotypes exist at the time of MI, notably severe insulin-deficient and mild age-related.
• These phenotypes can be estimated using clinical and biochemical markers.
• Low glomerular function rate is a significant risk factor for adverse cardiovascular outcomes post-MI in T2D patients.