Trends in incidence and case fatality of acute myocardial infarction, angina and coronary revascularisation in people with and without type 2 diabetes in Scotland between 2006 and 2015

Abstract

Aims/hypothesis The aim of the study was to examine trends in the incidence and case fatality of acute myocardial infarction (AMI) and in hospital admissions for angina and coronary revascularisation procedures in people with type 2 diabetes and in people without diabetes in Scotland between 2006 and 2015.Methods In this retrospective cohort study, AMI, angina and revascularisation event data were obtained for adults from hospital admissions and death records linked to a population-based diabetes register. Incidence by diabetes status was estimated using negative binomial models with adjustment or stratification by age, sex, deprivation and calendar year. Logistic regression was used to estimate AMI case fatality by diabetes status. Results There were 129,926 incident AMI events, 41,263 angina admissions and 69,875 coronary revascularisation procedures carried out during 34.9 million person-years of follow-up. The adjusted incidence of AMI, angina and revascularisation procedures declined by 2.0% (95% CI 1.73%, 2.26%), 9.62% (95% CI 9.22%, 10.01%) and 0.35% (95% CI −0.09%, 0.79%) per year, respectively. The rate of decline did not differ materially by diabetes status. RRs of AMI for type 2 diabetes were 1.86 (95% CI 1.74, 1.98) for men and 2.32 (95% CI 2.15, 2.51) for women. Of the 77,211 people admitted to hospital with a first AMI, 7842 (10.2%) died within 30 days of admission. Case fatality was higher in people with type 2 diabetes than in people without diabetes and declined in both groups by 7.93% (95% CI 7.03%, 8.82%) per year. Conclusions/interpretation The incidence of AMI, angina, revascularisation and AMI case fatality has declined over time, but the increased risk associated with type 2 diabetes has remained approximately constant.

Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025

“…In contrast, the mortality reported by IDF is calculated from relative risks and total numbers of deaths from cohort studies comparing death rates in those with and without diabetes including both direct and indirect mortality 4 . It is well known that diabetes is associated with increasing incidence and death due to cardiovascular and cerebrovascular disease, cancer, infectious disease, which results in increased indirect mortality associated with diabetes 24 .…”

Prescribing Paradigm Shift? Applying the 2019 European Society of Cardiology–Led Guidelines on Diabetes, Prediabetes, and Cardiovascular Disease to Assess Eligibility for Sodium–Glucose Cotransporter 2 Inhibitors or Glucagon-Like Peptide 1 Receptor Agonists as First-Line Monotherapy (or Add-on to Metformin Monotherapy) in Type 2 Diabetes in Scotland

“…It is also unclear whether the discriminatory ability of the ESC-led risk stratification system has been validated and whether it truly identifies those who benefit most from treatment with an SGLT-2i or a GLP1RA or results in over estimation of CV risk and consequently overprescribing, particularly in light of more complex risk assessment tools recently being shown to over-estimate CV risk in T2D. 19,20 The guidelines' algorithm for risk stratification might, indeed, be considered crude in light of more refined cardiovascular risk engines for T2D becoming available. 20 Whether it is possible to have specific risk scores that includes risk for major adverse cardiovascular events, and HF, should also be urgently investigated.…”

Prevalence, characteristics, and prognostic implications of type 2 diabetes in patients with myocardial infarction: the Polish Registry of Acute Coronary Syndromes (PL‑ACS) annual 2018 report

“…2 Diabetes may be found in 13.7% to 35.6% of patients with MI and is associated with worse clinical parameters, higher prevalence of comorbidities, and a greater extent of CAD. [2][3][4][5] These patients are also characterized by increased in -hospital mortality, both in men (11.7% in DM vs 7.8% in non -DM) and women (15.6% in DM vs 12.6% in non -DM). 3 Proper in -hospital treatment and treatment recommended at discharge are of great importance in patients with DM.…”

“…[2][3][4][5] These patients are also characterized by increased in -hospital mortality, both in men (11.7% in DM vs 7.8% in non -DM) and women (15.6% in DM vs 12.6% in non -DM). 3 Proper in -hospital treatment and treatment recommended at discharge are of great importance in patients with DM. As the Polish Registry of Acute Coronary Syndromes in DM patients.…”

“…This observation is consistent with previous studies, in which in--hospital mortality varied between 1.43% (MUL-TIPRAC) and 9.42% (Belgian STEMI) in patients with DM and ACS and between 0.34% (MULTIP-RAC) and 6.63% (Belgian STEMI) in those with ACS but no DM. 3,5 Comparing the hospital treatment of DM in patients with and without LVSD, patients with LVSD received insulin treatment more often, while patients without LVSD, oral antidiabetic drugs. Similar observations were done at discharge.…”