A Meta-analysis For The Recurrence Of Cardiovascular Events Associated With Hypertension And Diabetes Mellitus After Acute Myocardial Infarction

Objective: To evaluate the effect of hypertension and diabetes mellitus with adverse cardiovascular events in survivors of acute myocardial infarction through meta-analysis.Methods: We searched randomized clinical trials from four database, including PubMed, CNKI, English Medical Current Contents and Chinese BioMedical Disc, and the references of eligible studies were manually searched. The aim of the trials was to explicit the impact of hypertension or diabetes mellitus in patients after acute myocardial infarction on the recurrence of adverse cardiovascular events. Relative risk (RR) and 95% confidence interval (CI) were calculated using fixed effects models or random effects models. Statistical analysis was performed by using Review Manager 4.2.Results: Eight randomized clinical trials of diabetes mellitus after myocardial infarction, which enrolled a total of 19755 patients, were included in the meta-analysis. Diabetes mellitus significantly increased all-cause mortality in the survivors of myocardial infarction (RR=1.68, 95% CI [1.28, 2.19], P = 0.0002). Diabetes mellitus significantly increased the incidence of reinfarction in the survivors of myocardial infarction (RR=1.73, 95% CI [1.04, 2.14], P<0.00001). Diabetes mellitus significantly increase the incidence of disabling stroke in the survivors of myocardial infarction (RR= 2.46, 95% CI [1.04, 5.85], P = 0.04). Five randomized controlled trials of hypertension after myocardial infarction, which enrolled a total of 18365 patients, were included in the meta-analysis. Hypertension significantly increased all-cause mortality in the survivors of myocardial infarction (RR=1.28, 95% CI [1.14,1.43], P<0.0001). Hypertension significantly increased the incidence of heart failure in the survivors of myocardial infarction (RR=1.43, 95% CI [1.11, 1.84], P=0.006). Hypertension significantly increased the incidence of cardiovaccualr mortality in the survivors of myocardial infarction (RR=1.36, 95% CI [1.22,1.51], P<0.00001). Hypertension did not increase the incidence of reinfarction in the survivors of myocardial infarction (RR=1.28, 95% CI [0.94, 1.74], P = 0.12). Hypertension did not increase the incidence of stroke in the survivors of myocardial infarction (RR=1.32, 95% CI [0.92, 1.89], P =0.13).Conclusions: Diabetes mellitus significantly increased all-cause mortality, the incidence of disabling stroke and reinfarction in the survivors of myocardial infarction. Hypertension significantly increased all-cause mortality, the incidence of heart failure and cardiovascular mortality in the survivors of myocardial infarction. Hypertension did not increase the incidence of reinfarction and stroke in the survivors of myocardial infarction.