title: Changes in short- and long-term cardiovascular risk of incident diabetes and incident myocardial infarction--a nationwide study.
abstract: OBJECTIVE
  We assessed secular trends of cardiovascular outcomes following first diagnosis of myocardial infarction (MI) or diabetes in an unselected population.
  
  
  METHODS
  All Danish residents aged > or = 30 years without prior diabetes or MI were identified by individual-level linkage of nationwide registers. Individuals hospitalised with MI or claiming a first-time prescription for a glucose-lowering medication (GLM) during the period from 1997 to 2006 were included. Analyses were by Poisson regression models. Primary endpoints were death by all causes, cardiovascular death and MI.
  
  
  RESULTS
  The study included 3,092,580 individuals, of whom 77,147 had incident MI and 118,247 new-onset diabetes. MI patients had an increased short-term risk of all endpoints compared with the general population. The rate ratio (RR) for cardiovascular death within the first year after MI was 11.1 (95% CI 10.8-11.5) in men and 14.8 (14.3-15.3) in women, respectively. The risk rapidly declined and 1 year after the index MI, RR was 2.11 (2.00-2.23) and 2.8 (2.64-2.97) in men and women, respectively. Patients with diabetes carried a constantly elevated risk of all endpoints compared with the general population. The cardiovascular death RR was 1.90 (1.77-2.04) and 1.92 (1.78-2.07) in men and women, respectively during the first year after GLM initiation.
  
  
  CONCLUSIONS
  Incident MI is associated with high short-term risk, which decreases rapidly over time. Incident diabetes is associated with a persistent excessive cardiovascular risk after initiation of GLM therapy. This further strengthens the necessity of early multi-factorial intervention in diabetes patients for long-term benefit.
authors.affiliation: Department of Cardiology, Gentofte Hospital, Niels Andersens Vej 65, DK 2900 Hellerup, Denmark. mln@heart.dk
authors.forename: M L
authors.initials: ML
authors.lastname: Norgaard
authors.forename: S S
authors.initials: SS
authors.lastname: Andersen
authors.forename: T K
authors.initials: TK
authors.lastname: Schramm
authors.forename: F
authors.initials: F
authors.lastname: Folke
authors.forename: C H
authors.initials: CH
authors.lastname: Jørgensen
authors.forename: M L
authors.initials: ML
authors.lastname: Hansen
authors.forename: C
authors.initials: C
authors.lastname: Andersson
authors.forename: D M
authors.initials: DM
authors.lastname: Bretler
authors.forename: A
authors.initials: A
authors.lastname: Vaag
authors.forename: L
authors.initials: L
authors.lastname: Køber
authors.forename: C
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: G H
authors.initials: GH
authors.lastname: Gislason
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D012042:Registries; D012306:Risk; D012307:Risk Factors; D013997:Time Factors
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