Women and Heart Disease: The Role of Diabetes and Hyperglycemia

Archives of Internal Medicine

Volumn 164, Issue 9, 2004, Pages 934-942

  Barrett Connor, Elizabeth ^a   Giardina, Elsa Grace V ^b   Gitt, Anselm K ^c   Gudat, Uwe ^d   Steinberg, Helmut O ^e   Tschoepe, Diethelm ^f  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b NewYork Presbyterian Columbia University Irving Medical Center   (United States)

^c Department of Cardiology   (Germany)

^d Arataeus Sarl   (Switzerland)

^e INDIANA UNIVERSITY SCHOOL OF MEDICINE   (United States)

^f RUHR UNIVERSITY BOCHUM   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; ANTIHYPERTENSIVE AGENT; ANTILIPEMIC AGENT; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CHOLESTEROL; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; GLUCOSE; HEMOGLOBIN A1C; HIGH DENSITY LIPOPROTEIN CHOLESTEROL; LOW DENSITY LIPOPROTEIN CHOLESTEROL;

ADULT; AGED; AGING; ATHEROSCLEROSIS; CARDIOVASCULAR DISEASE; CIGARETTE SMOKING; CONTROLLED STUDY; DIABETES CONTROL; DIABETES MELLITUS; DISEASE DURATION; DYSLIPIDEMIA; FEMALE; GLUCOSE BLOOD LEVEL; HUMAN; HYPERGLYCEMIA; HYPERTENSION; ISCHEMIC HEART DISEASE; MAJOR CLINICAL STUDY; MORTALITY; NON INSULIN DEPENDENT DIABETES MELLITUS; OUTCOMES RESEARCH; PRIORITY JOURNAL; QUALITY OF LIFE; REVIEW; RISK ASSESSMENT; RISK FACTOR; THROMBOSIS;

DIABETES MELLITUS; DIABETIC ANGIOPATHIES; ENDOTHELIUM, VASCULAR; FEMALE; HUMANS; HYPERGLYCEMIA; HYPERLIPIDEMIAS; PLATELET ACTIVATION; RISK FACTORS; SMOKING; THROMBOSIS; WOMEN'S HEALTH;

EID: 2342533875     PISSN: 00039926     EISSN: None     Source Type: Journal    
DOI: 10.1001/archinte.164.9.934     Document Type: Review

References (111)

1. Mokdad AH, Bowman BA, Ford ES. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286:1195-1200.
2. Calles-Escandon J, Garcia-Rubi E, Mirza S, Mortensen A. Type 2 diabetes: one disease, multiple cardiovascular risk factors. Coron Artery Dis. 1999;10:23-30.
3. American Heart Association. Women and Cardiovascular Disease. Women, Heart Disease and Stroke Statistics. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4787. Accessed February 11, 2004.
4. American Heart Association. Journal Report, February 4, 2004. Survey finds increased cardiovascular disease awareness among women but plenty of room for improvement. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3018814. Accessed February 11, 2004.
5. Kannel WB. Blood pressure as a cardiovascular risk factor. JAMA. 1996;275:1571-1576.
6. Wilson PWF, Kannel WB. Epidemiology of hyperglycemia and atherosclerosis. In: Ruderman N, et al, eds. Hyperglycemia, Diabetes and Vascular Disease. New York, NY: Oxford University Press; 1992:21-29.
7. Kannel WG, McGee DL. Diabetes and cardiovascular risk factors: the Framingham Study. Circulation. 1979;59:8-13.
8. Loewel H, Koenig W, Engel S, et al. The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment? results of a population-based myocardial infarction registry follow-up study. Diabetologia. 2000;43:218-216.
9. Miettinin H, Lehto S, Salomaa V, et al, the FINMONICA Myocardial Infarction Registry Study Group. Impact of diabetes on mortality after the first myocardial infarction. Diabetes Care. 1998;21:69-75.
10. Heyden S, Heiss G, Bartel AG, Hames CG. Sex differences in coronary mortality among diabetics in Evans County, Georgia. J Chron Dis. 1980;33:265-273.
11. Pan WH, Cedres LB, Liu K, et al. Relationship of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease mortality in men and women. Am J Epidemiol. 1986;123:504-516.
12. Elveback LR, Connoly DC, Melton LJ III. Coronary heart disease in residence of Rochester, Minnesota, VIII: incidence, 1950 through 1982. Maya Clin Proc. 1986;61:896-900.
13. De Stefano F, Ford ES, Newman J, et al. Risk factors of coronary heart disease mortality among persons with diabetes. Ann Epidemiol. 1993;3:27-34.
14. Sprafka JM, Pankow J, McGovern PG, French LR. Mortality among type 2 diabetic individuals and associated risk factors. Diabet Med. 1993;10:627-632.
15. Gu K, Cowie CC, Harris MI. Mortality in adults with and without diabetes in a national cohort of the US population, 1971-1993. Diabetes Care. 1998;21:1138-1145.
16. Turner RC, Millns H, Neil HAW, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: the United Kingdom Prospective Diabetes Study Group (UKPDS 23). BMJ. 1998;316:823-828.
17. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229-234.
18. Hu FB, Stampfer MJ, Solomon CG, et al. The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up. Arch Intern Med. 2001;161:1717-1723.
19. Peeters A, Mamun AA, Willekens, Bonneux L. A cardiovascular life history. Eur Heart J. 2002;23:458-466.
20. Table 12: Estimated life expectancy at birth in years, by race and sex: Death-registration States, 1900-28, and United States, 1929-99. Natl Vital Stat Rep. 2002;50(6):33-34. Available at: http://www.lifeexpectancy.com/le_birth.pdf. Accessed February 11, 2004.
21. Gregg EW, Mangione CM, Cauley JA, et al, the Study of Osteoporotic Fractures Research Group. Diabetes and the incidence of functional disability in older women. Diabetes Care. 2002;25:61-67.
22. Harris MI. Impaired glucose tolerance in the US population. Diabetes Care. 1989;12:464-474.
23. Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. Diabetes Care. 1999;22:233-240.
24. Edelstein SL, Knowier WC, Bain RP, et al. Predictors of progression from impaired glucose tolerance to NIDDM. Diabetes. 1997;46:701-710.
25. Scheidt-Nave C, Barrett-Connor E, Wingard DL, et al. Sex differences in fasting glycemia as a risk factor for ischemic heart disease. Am J Epidemiol. 1991;133:565-576.
26. Balkau B, Bertrais S, Ducimetiere P, Eschwege E. Is there a glycemic threshold for mortality risk? Diabetes Care. 1999;22:696-669.
27. Balkau B, Shipley M, Jarrett R, et al. High blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men: 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policeman Study. Diabetes Care. 1998;21:360-367.
28. de Vegt F, Decker JM, Ruhe HG, et al. Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn Study. Diabetologia. 1999;42:926-931.
29. Saydah SH, Montserrat M, Sung J, et al. Post-challenge hyperglycemia and mortality in a national sample of US adults. Diabetes Care. 2001;24:1397-1402.
30. Khaw K, Wareham N, Luben R, et al. Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European prospective investigation of cancer and nutrition (EPIC-Norfolk). BMJ. 2001;322:1-6.
31. Barrett-Connor E, Ferrara A. Isolated postchallenge hyperglycemia and the risk of fatal cardiovascular disease in older women and men. Diabetes Care. 1998;21:1236-1239.
32. Wei M, Gaskill SP, Haffner SM, Stern MP. Effects of diabetes and level of glycemia on all-cause and cardiovascular mortality: the San Antonio Heart Study. Diabetes Care. 1998;21:1167-1172.
33. Barrett-Connor EL, Cohn BA, Wingard DL, Edelstein SL. Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? JAMA. 1991;265:627-631.
34. Ilercil A, Devereux RB, Roman MJ, et al. Relationship of impaired glucose tolerance to left ventricular structure and function: the Strong Heart Study. Am Heart J. 2001;141:992-998.
35. Uusitupa MJ, Niskanen LK, Voutilaninen E, Pyorala K. Ten year cardiovascular mortality in relation to risk factors and abnormalities in lipoprotein composition in type 2 (non-insulin dependent) diabetic and non-diabetic subjects. Diabetologia. 1993;36:1175-1184.
36. Andersson DK, Svardsudd K. Long-term glycemic control relates to mortality in type II diabetes. Diabetes Care. 1995;18:1534-1543.
37. Hanefeld M, Fischer S, Julius U, et al. Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia. 1996;39:1577-1583.
38. Kuusisto J, Mykkanen L, Pyorala K, Laakso M. NIDM and its metabolic control predict coronary heart disease in elderly subjects. Diabetes. 1994;43:960-967.
39. Standl E, Balletshofer B, Dahl B, et al. Predictors of 10-year macrovascular and overall mortality in patients with NIDDM: the Munich General Practitioner Project. Diabetologia. 1996;39:1540-1545.
40. Niskanen L, Turpeinen A, Penttila I, Uusitupa MI. Hyperglycaemia and compositional lipoprotein abnormalities as predictors of cardiovascular mortality in type 2 diabetes: 15-year follow-up from the time of diagnosis. Diabetes Care. 1998;21:1861-1869.
41. Klein R. Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care. 1995;18:258-268.
42. Stratton IM, Adler AL, Neil HA. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405-412.
43. Laakso M. Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes. 1999;48:937-942.
44. Eschwege E, Richard JL, Thibult N, et al. Coronary heart disease mortality in relation with diabetes, blood glucose, and plasma insulin levels: the Paris Prospective Study, ten years later. Horm Metab Res Suppl. 1985;15:41-46.
45. Kowalska I, Prokop J, Bachorzewska-Gajewska, et al. Disturbances of glucose metabolism in men referred for coronary arteriography. Diabetes Care. 2001;24:897-901.
46. Meinert CL, Knatterud GL, Prout TE, Klimt CR. A study of the effects of hypoglycemic agents on vascular complications on patients with adult-onset diabetes, II: mortality results. Diabetes. 1970;19(suppl):789-830.
47. University Group Diabetes Program: a study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes, V: evaluation of phenformin therapy. Diabetes. 1975;24 (suppl 1):65-84.
48. Gaede P, Vedel P, Parving HH, Pedersen O. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet. 1999;353:617-622.
49. Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular disease in Japanese patients with non-insulin dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28:103-117.
50. Shichiri M, Kishikawa Ohkubo Y, Wake N. Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients. Diabetes Care. 2000;23(suppl 2):B21-B29.
51. UKPDS group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet. 1998;352:837-853.
52. Malmberg K, Norhammar A, Wedel H, Ryden L. Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes Mellitus and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation. 1999;99:2626-2632.
53. Malmberg K, for the DIGAMI (Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction) study group. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. BMJ. 1997;314:1512-1515.
54. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-986.
55. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2004;27(suppl 1):S15-S35.
56. Jensen-Urstad KJ, Reichard PG, Rosfors JS, Lindblad LE, Jensen-Urstad MT. Early atherosclerosis is retarded by improved long-term blood glucose control in patients with IDDM. Diabetes. 1996;45:1253-1258.
57. Grundy SM, Howard B, Smith S Jr, et al. Prevention Conference VI: diabetes and cardiovascular disease: executive summary: conference proceeding for healthcare professionals from a special writing group of the American Heart Association. Circulation. 2002;105:2231-2239.
58. Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature. 1980;288:373-376.
59. Steinberg HO, Paradisi G, Cronin J, et al. Type II diabetes abrogates sex differences in endothelial function in premenopausal women. Circulation. 2000;101:2040-2046.
60. Silva JA, Escobar A, Collins TJ, Ramee SR, White CJ. Unstable angina: a comparison of angioscopic findings between diabetic and nondiabetic patients. Circulation. 1995;92:1731-1736.
61. Chan P, Pan WH. Coagulation activation in type 2 diabetes mellitus: the higher coronary risk of female diabetic patients. Diabet Med. 1995;12:504-507.
62. Carr MD. Diabetes mellitus: a hypercoagulable state. J Diabetes Complications. 2001;15:44-54.
63. Mansfield MW, Heywood DM, Grant PJ. Sex differences in coagulation and fibrinolysis in white subjects with non-insulin-dependent diabetes mellitus. Arterioscler Thromb Vasc Biol. 1996;16:160-164.
64. Sobel BE, Woodcock-Mitchell J, Schneider DJ, et al. Increased plasminogen activator inhibitor type 1 in coronary artery atherectomy specimens from type 2 diabetic compared with non-diabetic patients: a potential factor predisposing to thrombosis and its persistence. Circulation. 1998;97:2213-2221.
65. Saito I, Folsom AR, Brancati FL, Duncan BB, Chambless LE, McGovern PG. Nontraditional risk factors for coronary heart disease incidence among persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) Study. Ann Intern Med. 2000;133:81-91.
66. Tschoepe D, Roesen P. Heart disease in diabetes mellitus: a challenge for early diagnosis and intervention. Exp Clin Endocrinol Diabetes. 1998;106:16-24.
67. Topol EJ, Serryus PW. Frontiers in interventional cardiology. Circulation. 1998;98:1802-1820.
68. Topol EJ. Towards a new frontier in myocardial reperfusion therapy: emerging platelet preeminence. Circulation. 1998;97:211-218.
69. Tschoepe D, Roesen P, Kaufmann L, et al. Evidence for abnormal platelet glycoprotein expression in diabetes mellitus. Eur J Clin Invest. 1990;20:166-170.
70. Tschoepe D, Roesen P, Esser J, et al. Large platelets circulate in an activated state in diabetes mellitus. Semin Thromb Hemost. 1991;17:433-438.
71. Ceriello A. Coagulation activation in diabetes mellitus: the role of hyperglycaemia and therapeutic prospects. Diabetologia. 1993;36:1119-1125.
72. Buenting CE, Koschinsky T, Schwippert B, et al. Food advanced glycation end products induce activation of platelets by increasing expression for AGE. Diabetologia. 2001;44(suppl 1):123.
73. Davi G, Guagnano MT, Ciabattoni G, et al. Platelet activation in obese women: role of inflammation and oxidant stress. JAMA. 2002;288:2008-2014.
74. Gum PA, Thumilarasan M, Watanabe J, Blackstone EH, Lauer MS. Aspirin use and all cause mortality among patients being evaluated for known or suspected coronary artery disease. JAMA. 2001;286:1187-1194.
75. Uusitupa M, Louheranta A, Lindstrom J, et al. The Finnish Diabetes Prevention Study. Br J Nutr. 2000;83(suppl 1):S137-S142.
76. Knowler WC, Barrett-Connor E, Fowler SE, et al, Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
77. US Preventive Services Task Force. Task force issues two recommendations on screening for diabetes in adults and pregnant women. February 3, 2003. Available at: http://www.ahcpr.gov/news/press/pr2003/diabscpr.htm. Accessed February 15, 2004.
78. Wingard DL, Barrett-Connor E, Criqui MH, Suarez L. Clustering of heart disease risk factors in diabetic compared to nondiabetic adults. Am J Epidemiol. 1983;117:19-26.
79. Howard BV, for the Strong Heart Study Investigators. Adverse effects of diabetes on multiple cardiovascular disease risk factors in women: the Strong Heart Study. Diabetes Care. 1998;21:1258-1265.
80. The Hypertension Study Group. Hypertension in diabetes study: prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications. J Hypertens. 1993;11:309-317.
81. United Kingdom Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703-713.
82. Curb JD, Pressel SL, Cutler JA, et al, Systolic Hypertension in the Elderly Program Cooperative Research Group. Effect of diuretic-based antihypertensive treatment on cardiovascular risk in older diabetic patients with isolated systolic hypertension. JAMA. 1996;276:1886-1892.
83. Hanson L, Zanchetti A, Carruthers SG, et al. Effect of intensive blood-pressure lowering and low dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment randomized trial. Lancet. 1998;351:1755-1762.
84. Barrett-Connor E, Grundy SM, Holdbrook JJ. Plasma lipids and diabetes mellitus in an adult community. Am J Epidemiol. 1982;115:657-663.
85. Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Franco LJ. Sex difference in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans: the San Antonio Heart Study. Am J Epidemiol. 1984;120:834-851.
86. Pyorala K, Pedersen TR, Kjekhus J, et al. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with heart disease. Diabetes Care. 1997;20:614-620.
87. Sacks FM, Pfeffer MA, Moye LA, et al, for the Cholesterol and Recurrent Events trial investigatots. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels: Cholesterol and Recurrent Events trial investigators. N Engl J Med. 1996;335:1001-1009.
88. Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) study group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349-1357.
89. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7-22.
90. Massing MW, Foley KA, Sueta CA, et al. Trends in lipid management among patients with coronary artery disease: has diabetes received the attention it deserves? Diabetes Care. 2003;26:991-997.
91. Al-Delaimy WK, Willett WC, Manson JE, Speizer FE, Hu FB. Smoking and mortality among women with type 2 diabetes. Diabetes Care. 2001;24:2043-2048.
92. Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345:790-797.
93. Rathor SS, Chen JS, Wang Y, Radford MJ, Vaccarino V, Krumholz H. Sex differences in cardiac catheterization: the role of physician gender. JAMA. 2001;286:2849-2856.
94. Philpott S, Boynton PM, Feder G, Hemingway H. Gender differences in descriptions of angina symptoms and health problems immediately prior to angiography: the ACRE study. Soc Sci Med. 2001;52:1565-1575.
95. Canto JG, Shlipak MG, Rogers WJ, et al. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA. 2000;283:3223-3229.
96. Ambepitya G, Kopelman P, Ingram B, et al. Exertional myocardial ischemia in diabetes: a quantitative analysis of anginal perceptual threshold and the influence of autonomic function. J Am Coll Cardiol. 1990;15:72-77.
97. Knopp RH. Estrogen, female gender, and heart disease. In: Topol EJ, ed. Textbook of Cardiovascular Disease. Philadelphia, Pa: Lippincott-Raven Publishers; 1998:195-218.
98. Douglas PS, Ginsburg GS. The evaluation of chest pain in women. N Engl J Med. 1996;334:1311-1315.
99. Wenger NK. Coronary heart disease in women: gender differences in diagnostic evaluation. J Am Med Wom Assoc. 1994;49:181-185.
100. Mark DB. Sex bias in cardiovascular care: should women be treated more like men [editorial]? JAMA. 2000;283:659-661.
101. Olson JD, Edmundowicz D, Becker DJ, et al. Coronary calcium in adults with type 1 diabetes: a stronger correlate of clinical coronary artery disease in men than in women. Diabetes. 2000;49:1571-1578.
102. Heer T, Schiele R, Gitt AK, et al. Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA Registry). Am J Cardiol. 2002;89:511-517.
103. Bairey Merz CN, Kelsey SF, Pepine CG, et al. The Women's Ischemia Syndrome Evaluation (WISE) study: protocol design, methodology, and feasibility report. J Am Coll Cardiol. 1999;33:1453-1461.
104. Vaccarino V, Parsons L, Every NR, et al. Sex-based differences in early mortality after myocardial infarction. N Engl J Med. 1999;341:217-225.
105. Wong Y, Rodwell A, Dawkins S, Livesey SAA, Simpson IA. Sex differences in investigation results and treatment in subjects referred for treatment of chest pain. Heart. 2001;85:149-152.
106. Dorsch MF, Lawrence RA, Sapsford RJ, et al. Poor prognosis of patients presenting with symptomatic myocardial infarction but without chest pain. Heart. 2001;86:494-498.
107. Gitt AK, Senges J. The patient with acute myocardial infarction who does not receive reperfusion treatment. Heart. 2001;86:243-245.
108. Stamler J, Stamler R, Neaton JD, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy. JAMA. 1999;282:2012-2018.
109. Anderson RN. A method for constructing complete annual US life tables. Vital Health Stat 2. 2000;129:1-28.
110. HOPE Study Investigators. Effects of an ACE inhibitor, ramipril, on death from cardiovascular causes, MI, and stroke in high risk patients. N Engl J Med. 2000;342:145-153.
111. Frilling B, Schiele R, Gitt AK, et al. Characterization and clinical course of patients not receiving aspirin for acute myocardial infarction: results from the MITRA and MIR studies. Am Heart J. 2001;141:200-205.