title: Long-term all-cause and cardiovascular mortality following incident myocardial infarction in men and women with and without diabetes: Temporal trends from 1998 to 2009.
abstract: Long-term mortality following myocardial infarction is higher in diabetic than non-diabetic individuals. Early case-fatality after myocardial infarction has improved but it is unclear whether trends extend to long-term mortality. We aimed to determine whether the disparity in long-term all-cause and cardiovascular disease mortality by diabetes status has decreased.
  
  
  
  All incident myocardial infarction cases were identified from Western Australian whole-population linked data for 1998-2009. Mortality follow-up was available until 30 June 2011. Unadjusted survival was estimated using Kaplan-Meier survival curves. Hazard ratios comparing five-year mortality in diabetic versus non-diabetic people across three periods (1998-2001, 2002-2005, 2006-2009) were estimated from multivariable Cox regression models, and adjusted trends calculated from interaction (diabetes status × period) models.
  
  
  
  There were 22,594 30-day survivors of incident MI. There was little change across the three periods in all-cause mortality in diabetic men (27.1%, 28.2%, 25.5%) and women (34.9%, 36.8%, 36.1%), but small declines from first to last periods in non-diabetic men (14.5% to 12.1%, p = 0.03) and women (21.0% to 19.4%, p = 0.08). There was no temporal change in the increased all-cause mortality hazard ratios in diabetic versus non-diabetic men and women. Multivariable-adjusted relative risk for cardiovascular disease mortality remained elevated in diabetic women (2006-2009 hazard ratio 1.73, 95% confidence interval 1.29, 2.32) but not in men (2006-2009 hazard ratio 1.08, 95% confidence interval 0.85, 1.37).
  
  
  
  The excess long-term mortality associated with diabetes and excess cardiovascular disease mortality in diabetic women indicates a need for improved secondary prevention in diabetic patients, especially women.
authors.affiliation: School of Population Health, The University of Western Australia, Perth, Australia lee.nedkoff@uwa.edu.au.
authors.forename: Lee
authors.initials: L
authors.lastname: Nedkoff
authors.affiliation: School of Population Health, The University of Western Australia, Perth, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Knuiman
authors.affiliation: School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hung
authors.affiliation: School of Population Health, The University of Western Australia, Perth, Australia.
authors.forename: Tom G
authors.initials: TG
authors.lastname: Briffa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death / Q000639:trends; D003920:Diabetes Mellitus; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D014904:Western Australia / Q000453:epidemiology
keywords: Diabetes; mortality; myocardial infarction; trends