Diabetes Is Associated With Worse Long-term Outcomes in Young Adults After Myocardial Infarction: The Partners YOUNG-MI Registry

OBJECTIVE We sought to determine the prevalence of diabetes and associated cardiovascular outcomes in a contemporary cohort of young individuals presenting with their first myocardial infarction (MI) at age <= 50 years. RESEARCH DESIGN AND METHODS We retrospectively analyzed records of patients presenting with a first type 1 MI at age <= 50 years from 2000 to 2016. Diabetes was defined as a hemoglobin A(1c)>= 6.5% (48 mmol/mol) or a documented diagnosis of or treatment for diabetes. Vital status was ascertained for all patients, and cause of death was adjudicated. RESULTS Among 2,097 young patients who had a type 1 MI (mean age 44.0 +/- 5.1 years, 19.3% female, 73% white), diabetes was present in 416 (20%), of whom 172 (41%) were receiving insulin. Over a median follow-up of 11.2 years (interquartile range 7.3-14.2 years), diabetes was associated with a higher all-cause mortality (hazard ratio 2.30;P< 0.001) and cardiovascular mortality (2.68;P< 0.001). These associations persisted after adjusting for baseline covariates (all-cause mortality: 1.65;P= 0.008; cardiovascular mortality: 2.10;P= 0.004). CONCLUSIONS Diabetes was present in 20% of patients who presented with their first MI at age <= 50 years and was associated with worse long-term all-cause and cardiovascular mortality. These findings highlight the need for implementing more aggressive therapies aimed at preventing future adverse cardiovascular events in this population.