Changes in short- and long-term cardiovascular risk of incident diabetes and incident myocardial infarction--a nationwide study.
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.
Norgaard
M L
ML
Department of Cardiology, Gentofte Hospital, Niels Andersens Vej 65, DK 2900 Hellerup, Denmark. mln@heart.dk
Andersen
S S
SS
Schramm
T K
TK
Folke
F
F
Jørgensen
C H
CH
Hansen
M L
ML
Andersson
C
C
Bretler
D M
DM
Vaag
A
A
Køber
L
L
Torp-Pedersen
C
C
Gislason
G H
GH
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
Eur Heart J. 2006 May;27(10):1153-8
16399775
Clin Cardiol. 2001 Mar;24(3 Suppl):I3-7
11286312
Diabetes Care. 2006 Feb;29(2):391-7
16443893
N Engl J Med. 2008 Jun 12;358(24):2545-59
18539917
N Engl J Med. 1998 Jul 23;339(4):229-34
9673301
Eur Heart J. 2005 May;26(10):990-5
15618048
Br J Clin Pharmacol. 2005 Aug;60(2):150-8
16042668
J Am Coll Cardiol. 2006 Jan 3;47(1):65-71
16386666
Arch Intern Med. 2003 Feb 24;163(4):445-51
12588203
N Engl J Med. 2008 Jun 12;358(24):2560-72
18539916
Diabetes Care. 2008 Mar;31(3):596-615
18308683
Lancet. 2006 Jul 1;368(9529):29-36
16815377
J Manag Care Pharm. 2008 Apr;14(3):271-80
18439049
N Engl J Med. 2003 Aug 21;349(8):733-42
12930925
Diabetes Care. 2004 Mar;27(3):704-8
14988289
Dan Med Bull. 1999 Jun;46(3):263-8
10421985
J Clin Epidemiol. 2003 Feb;56(2):124-30
12654406
BMJ. 2008 Jul 01;337:a236
18595902
JAMA. 1999 Jun 2;281(21):2005-12
10359389
Circulation. 2004 Sep 7;110(10):1202-8
15313956
N Engl J Med. 2003 Jan 30;348(5):383-93
12556541
Scand Cardiovasc J. 2005 Apr;39(1-2):42-9
16097413
Circulation. 2008 Apr 15;117(15):1945-54
18378618
N Engl J Med. 1998 Jan 1;338(1):8-14
9414325
Chest. 2007 Feb;131(2):480-8
17296651
Open Cardiovasc Med J. 2009 Nov 12;3:152-9
20016749
Circulation. 2009 Apr 7;119(13):1728-35
19307472
N Engl J Med. 2009 Jan 8;360(2):129-39
19092145
Diabetes Care. 1992 Jul;15(7):815-9
1516497
Neuroepidemiology. 2007;28(3):150-4
17478969
Dan Med Bull. 1997 Sep;44(4):445-8
9377907
N Engl J Med. 2008 Feb 7;358(6):580-91
18256393
N Engl J Med. 2008 Oct 9;359(15):1577-89
18784090