Key result
Diabetes linked to ~22% higher long-term post-ACS mortality, with stronger risk in women.
Why the study?
The excess ACS burden and post-ACS mortality associated with diabetes and LDL-C target attainment, including sex differences, were not well quantified.
Does diabetes increase long-term mortality and affect LDL-C target attainment in patients following an acute coronary syndrome?
Cohort (n=5,361)
Does diabetes increase long-term mortality and affect LDL-C target attainment in patients following an acute coronary syndrome?
Hazard Ratio: 1.22 (95% CI 1.11–1.33)
Following acute coronary syndrome, diabetes remains a significant predictor of long-term mortality, particularly in women, and attainment of guideline-directed LDL-C goals remains persistently poor.
Diabetes associated with 36% higher long-term post-ACS mortality despite better LDL-C attainment; leaves open sex-specific risks and management.
AIMS: To quantify the excess acute coronary syndrome (ACS) burden and post-ACS mortality associated with diabetes and assess LDL-C target attainment, focusing on sex differences. METHODS: We conducted a retrospective cohort study including 5,361 patients with the first ACS admission identified during the study period (2016-2024) in a Spanish healthcare department. Hospitalization trends were analyzed using population-based regression models. Long-term mortality was assessed by Kaplan-Meier and multivariable Cox regression. LDL-C target attainment was evaluated according to ESC/EAS recommendations. RESULTS: Diabetes was present in 36.9 % of patients. ACS hospitalization rates declined by 8.3 % annually (95 % CI 6.1-10.4), with no diabetes-by-time interaction (p = 0.17). In-hospital case fatality was 6.3 % and did not differ by diabetes status. During a median 4.9-year follow-up, diabetes was associated with higher all-cause mortality (adjusted HR 1.22, 95 % CI 1.11-1.33), with a stronger association in women than men (interaction p = 0.009). Only 28.9 % achieved LDL-C < 55 mg/dL, with no temporal improvement; female sex independently predicted poor LDL-C control (adjusted OR 1.65, 95 % CI 1.38-1.97). CONCLUSIONS: Despite declining ACS hospitalizations, DM remained associated with increased long-term mortality, particularly in women. LDL-C target attainment remained suboptimal, highlighting persistent gaps in secondary prevention.
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Guerrero et al. (2026) conducted a cohort in acute coronary syndrome (ACS) (n=5,361). Diabetes vs. No diabetes was evaluated on all-cause mortality (HR 1.22, 95% CI 1.11-1.33). Diabetes was associated with higher long-term all-cause mortality following an acute coronary syndrome (adjusted HR 1.22; 95% CI 1.11-1.33), with a significantly stronger association in women.
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