Temporal trends in the initiation of glucose-lowering medications after a first-time myocardial infarction - a nationwide study between 1997 and 2006

Abstract

BackgroundType 2 diabetes is a well-established risk factor for cardiovascular disease and is common among patients with acute myocardial infarction (MI). The extent to which patients with first-time MI develop diabetes requiring glucose-lowering medications (GLM) is largely unknown. The aim of the study was to investigate temporal trends in the initiation of GLM among patients discharged after first-time MI.MethodsAll Danish residents aged ≥ 30 years without prior diabetes hospitalized with first-time MI between 1997 and 2006 were identified by individual-level-linkage of nationwide registers. Initiation of GLM during follow-up was assessed by claimed prescriptions from pharmacies. Temporal trends in initiation of GLM were assessed by incidence rate calculations in the MI population as in the general population. Multivariable Cox proportional-hazard models were used to investigate the likelihood of initiating GLM within a year post-MI.ResultsThe population comprised 66,788 patients. Among these patients 3962 patients initiated GLM, of whom 1567 started within one year post-MI. An increase in incidence rates of GLM initiation in the MI population from 19.6 per 1000 person years in 1997 to approximately 27.6 in 2001 was demonstrated. After 2001 the incidence rates stabilized. A similar trend was observed in the general population where the incidence rates increased from 2.8 in 1997 to 4.0 in 2004 and then stabilized.ConclusionOur study demonstrated an increase in incidence rates of GLM initiation within the first year post- MI. A similar trend was observed in the general population suggesting that the increase in GLM among MI patients was primarily the effect of a general increased awareness of diabetes. From a public heath perspective, this study underscores a continuous need for diagnostic and therapeutic improvement in the care of MI patients that develop diabetes.

Baseline comparison of three health utility measures and the feeling thermometer among participants in the action to control cardiovascular risk in diabetes trial

“…Researchers reviewed health records of all Danish myocardial infarction (MI) patients who were not previously diagnosed with diabetes to identify the initiation of glucose lowering medications within 1 year after discharge [ 50 ]. The rates increased from 19.6 to 27.6 per 1000 person year from 1997 to 2001, at which time the rates leveled off through 2005 [ 50 ]. These rates were much lower than expected, since other researchers had shown higher rates of abnormal glucose tolerance among MI patients.…”

Low Carbohydrate Diet From Plant or Animal Sources and Mortality Among Myocardial Infarction Survivors

“…Over the past several decades, improvements in clinical care, including more frequent use of reperfusion therapy and secondary prevention medications, have greatly increased patients' survival following myocardial infarction (MI) . At the same time, the characteristics of MI survivors have changed, with higher prevalence of obesity, metabolic syndrome, and type 2 diabetes …”

“…O ver the past several decades, improvements in clinical care, including more frequent use of reperfusion therapy and secondary prevention medications, have greatly increased patients' survival following myocardial infarction (MI). [1][2][3][4][5][6] At the same time, the characteristics of MI survivors have changed, with higher prevalence of obesity, metabolic syndrome, and type 2 diabetes. [1][2][3][4] The American Heart Association guidelines for coronary heart disease state that patients should be instructed to achieve and maintain a healthy weight (body mass index 18.5 to 24.9 kg/m 2 ) through changes in diet and physical activity [5][6][7][8] ; however, the effect of a weight-loss diet among MI survivors is unknown.…”

Glucose-lowering therapy and cardiovascular outcomes in patients with type 2 diabetes mellitus and acute coronary syndrome

“…Germaine to this, a study showed that, in the general population, there was an increase in the incidence rate of treatment based on glucose-lowering medication within the first year following MI: this suggests that after an acute coronary event, there is an increased awareness of diabetes. 117…”

“…117 Various classes of glucose-lowering therapies have been evaluated for their use following hospitalization for acute MI with heterogeneous results, even within the same drug class (Table 1). [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65]115,[117][118][119][120][121] In general, DPP-4inhibitors showed improved glycemic control with no increase of the risk of CV events or HF outcomes as compared with placebo. [59][60][61][62][63] Two of the recent cardiovascular outcome studies have been performed in diabetic patients with a recent ACS.…”