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November 28, 2007

Diabetes and Mortality Risk After Acute Coronary Syndromes

JAMA. 2007;298(20):2367-2368. doi:10.1001/jama.298.20.2367-b

To the Editor: Dr Donahoe and colleagues1 concluded that “despite modern therapies for ACS, diabetes conferred a significant independent excess mortality risk at 30 days and 1 year following ACS. Current strategies are insufficient to ameliorate the adverse impact of diabetes.” This conclusion was based on their analysis that found that patients with diabetes have higher risk of mortality compared with patients without diabetes after adjusting for treatment for ACS and discharge medications in a logistic regression model. However, treating a variable such as medications on discharge as a confounder and adjusting for it in a regression model can produce misleading results if an interaction is present.2,3

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