Which drugs benefit diabetic patients for secondary prevention of myocardial infarction? DARTS/MEMO Collaboration

Diabet Med. 1998 Apr;15(4):282-9. doi: 10.1002/(SICI)1096-9136(199804)15:4<282::AID-DIA591>3.0.CO;2-C.


Diabetic patients have increased mortality following myocardial infarction. We review the evidence for benefit in diabetic patients, of the major drug groups used as secondary prevention. Beta blockers: meta-analyses suggest a reduction in mortality of 35% with beta blockers. Diabetic patients should receive beta blockers post myocardial infarction. In many patients, the benefits of beta blockers will outweigh relative contraindications. Aspirin: meta-analyses of antiplatelet therapy in high-risk subjects have shown substantial benefits. Aspirin should be prescribed for secondary prevention. Lipid lowering with statins: subgroup analyses of the major secondary prevention trials show substantial benefits across a wide range of baseline cholesterol and LDL levels. These drugs should be prescribed as secondary prevention to patients with diabetes whose total cholesterol is > 4.0 mmol(-1). Angiotensin converting enzyme inhibitors (ACEIs): the few subgroup analyses that exist from ACEI trials suggest that diabetic and non-diabetic patients derive similar benefits. Diabetic subjects who have systolic dysfunction after myocardial infarction should receive ACEIs. Treatment combination: data exist to suggest that most of these drugs produce benefit independently.

Conclusion: diabetic patients benefit from secondary prevention with drug treatment as much as, or more than, non-diabetic patients.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Aspirin / therapeutic use
  • Diabetes Complications*
  • Humans
  • Hypolipidemic Agents / therapeutic use
  • Myocardial Infarction / etiology
  • Myocardial Infarction / prevention & control*
  • Simvastatin / therapeutic use


  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Hypolipidemic Agents
  • Simvastatin
  • Aspirin