Risk factors for myocardial infarction case fatality and stroke case fatality in type 2 diabetes: UKPDS 66.

OBJECTIVE Patients with diabetes have a higher case fatality rate in myocardial infarction (MI) or stroke than those without diabetes: that is, MI and stroke are more often fatal if diabetes is present. We investigated whether the risk of MI or stroke being fatal in type 2 diabetes can be estimated using information available around the time diabetes is diagnosed. RESEARCH DESIGN AND METHODS Analyses were based on 674 cases of MI (351 fatal) that occurred in 597 of 5,102 U.K. Prospective Diabetes Study (UKPDS) patients for whom covariate data were available during a median follow-up of 7 years. Multivariate logistic regression was used to examine differences in risk factors, measured within 2 years of diagnosis of diabetes, between fatal and nonfatal MI. Similar analyses were performed for 234 strokes (48 fatal) that occurred in 199 patients. RESULTS Patients with fatal MI had higher HbA(1c) than those with nonfatal MI (odds ratio 1.17 per 1% HbA(1c), P = 0.014). Patients with fatal stroke had higher HbA(1c) than those with nonfatal stroke (odds ratio 1.37 per 1% HbA(1c), P = 0.007). Other risk factors for MI case fatality included increased age, blood pressure, and urine albumin level. CONCLUSIONS The risk of MI or stroke being fatal in type 2 diabetes is associated with risk factors, including HbA(1c), measured many years before onset of MI or stroke. Equations have been added to the UKPDS Risk Engine to estimate likely case fatality rates in MI and stroke.

[1]  Stanley Lemeshow,et al.  Multiple Logistic Regression , 2005 .

[2]  Irene M. Stratton,et al.  UK prospective diabetes study (UKPDS) , 2004, Diabetologia.

[3]  M. Cakir,et al.  Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. , 2003, The Journal of clinical endocrinology and metabolism.

[4]  Mandeep Singh,et al.  Scores for Post–Myocardial Infarction Risk Stratification in the Community , 2002, Circulation.

[5]  R. Stevens,et al.  UKPDS 60: Risk of Stroke in Type 2 Diabetes Estimated by the UK Prospective Diabetes Study Risk Engine , 2002, Stroke.

[6]  A. Kitabchi,et al.  Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. , 2002, The Journal of clinical endocrinology and metabolism.

[7]  R. Holman,et al.  Erratum: The UKPDS risk engine: A model for the risk of coronary heart disease in type II diabetes (UKPDS 56) (Clinical Science (2001) 101 (671-679)) , 2002 .

[8]  R. Holman,et al.  The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56). , 2001, Clinical science.

[9]  David A Morrow,et al.  A simple risk index for rapid initial triage of patients with ST-elevation myocardial infarction: an InTIME II substudy , 2001, The Lancet.

[10]  J. McNeil,et al.  Incidence of the Major Stroke Subtypes: Initial Findings From the North East Melbourne Stroke Incidence Study (NEMESIS) , 2001, Stroke.

[11]  K. Yeo,et al.  Predicting CHD risk in patients with diabetes mellitus , 2001, Diabetic medicine : a journal of the British Diabetic Association.

[12]  J. Egido,et al.  Neurosonology in Cerebral Ischemia: Future Application of Transcranial Doppler in Acute Stroke , 2001, Cerebrovascular Diseases.

[13]  N. Wareham,et al.  Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk) , 2001, BMJ : British Medical Journal.

[14]  A. Dobson,et al.  Case fatality after an acute cardiac event: the effect of smoking and alcohol consumption. , 2001, Journal of clinical epidemiology.

[15]  M. Alderman,et al.  Myocardial infarction in treated hypertensive patients: the paradox of lower incidence but higher mortality in young blacks compared with whites. , 2000, Circulation.

[16]  H. Gerstein,et al.  Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview , 2000, The Lancet.

[17]  A. Memon,et al.  Clinical epidemiology of acute myocardial infarction in Kuwait , 2000, Acta cardiologica.

[18]  L. Clark,et al.  Cardiovascular disease in patients with diabetes: clinical considerations. , 1999, Journal of the Association for Academic Minority Physicians : the official publication of the Association for Academic Minority Physicians.

[19]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[20]  Uk-Prospective-Diabetes-Study-Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) , 1998, The Lancet.

[21]  M. Connaughton,et al.  Diabetes and coronary artery disease: time to stop taking the tablets? , 1998, Heart.

[22]  T. Truelsen,et al.  Stroke Incidence and Case Fatality in Two Populations: The Auckland Stroke Study and the Copenhagen City Heart Study , 1998, Neuroepidemiology.

[23]  M. Hobbs,et al.  Arrhythmias and Mortality After Myocardial Infarction in Diabetic Patients: Relationship to diabetes treatment , 1998, Diabetes Care.

[24]  LloydChambless,et al.  Population Versus Clinical View of Case Fatality From Acute Coronary Heart Disease , 1997 .

[25]  I. Mühlhauser,et al.  Possible risk of sulfonylureas in the treatment of non-insulin-dependent diabetes mellitus and coronary artery disease , 1997, Diabetologia.

[26]  Anthony C. Davison,et al.  Bootstrap Methods and Their Application , 1998 .

[27]  D. Ryglewicz,et al.  Basic analytical parameters as the predictive factors for 30‐day case fatality rate in stroke , 1997, Acta neurologica Scandinavica.

[28]  D. Yellon,et al.  Sulfonylurea KATP blockade in type II diabetes and preconditioning in cardiovascular disease. Time for reconsideration. , 1996, Circulation.

[29]  J Herlitz,et al.  Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. , 1995, Journal of the American College of Cardiology.

[30]  M. Schroll,et al.  Stroke incidence, case fatality, and mortality in the WHO MONICA project. World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease. , 1995, Stroke.

[31]  E. Shahar,et al.  Trends in Diabetes Prevalence Among Stroke Patients and the Effect of Diabetes on Stroke Survival: the Minnesota Heart Survey , 1994, Diabetic medicine : a journal of the British Diabetic Association.

[32]  D. Labarthe,et al.  The Relation of Diabetes to the Severity of Acute Myocardial Infarction and Post-Myocardial Infarction Survival in Mexican-Americans and Non-Hispanic Whites: The Corpus Christi Heart Project , 1994, Diabetes.

[33]  R. Stout,et al.  Hyperglycaemia and mortality from acute stroke. , 1994, The Quarterly journal of medicine.

[34]  R. Bonita Stroke trends in Australia and New Zealand: mortality, morbidity, and risk factors. , 1993, Annals of epidemiology.

[35]  R B D'Agostino,et al.  Secular trends in stroke in the Framingham Study. , 1993, Annals of epidemiology.

[36]  N. Taub,et al.  Does the incidence, severity, or case fatality of stroke vary in southern England? , 1993, Journal of epidemiology and community health.

[37]  R. Fogelholm,et al.  Blood glucose, glycosylated haemoglobin, and outcome of ischemic brain infarction , 1992, Journal of the Neurological Sciences.

[38]  J. Huttunen,et al.  Coronary Heart Disease Incidence in NIDDM Patients In The Helsinki Heart Study , 1992, Diabetes Care.

[39]  R. Hirsch,et al.  Stroke in China (Sino-MONICA-Beijing study) 1984-1986. , 1992, Neuroepidemiology.

[40]  R. Cooper,et al.  Age-Related Differences in Case-Fatality Rates Among Diabetic Patients With Myocardial Infarction: Findings from National Hospital Discharge Survey, 1979–1987 , 1991, Diabetes Care.

[41]  J. Manson,et al.  A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. , 1991, Archives of internal medicine.

[42]  E. Barrett-Connor,et al.  Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study. , 1991, JAMA.

[43]  K. Anderson,et al.  Cardiovascular disease risk profiles. , 1991, American heart journal.

[44]  R. Swaminathan,et al.  A case control study of some hematological and biochemical variables in acute stroke and their prognostic value. , 1990, Neuroepidemiology.

[45]  L. Muratori,et al.  Hyperglycemia and prognosis of acute myocardial infarction in patients without diabetes mellitus. , 1989, The American journal of cardiology.

[46]  T. Pillar,et al.  Incidence, mortality, and case-fatality rate of stroke in northern Israel. , 1989, Stroke.

[47]  P. Becker,et al.  Prognostic importance of admission plasma glucose in diabetic and non-diabetic patients with acute myocardial infarction. , 1989, The Quarterly journal of medicine.

[48]  D. Singer,et al.  Diabetic Myocardial Infarction: Interaction of Diabetes With Other Preinfarction Risk Factors , 1989, Diabetes.

[49]  B. Norrving,et al.  Epidemiology of stroke in Lund‐Orup, Sweden, 1983–85 , 1988, Acta neurologica Scandinavica.

[50]  E. Woo,et al.  Hyperglycemia is a stress response in acute stroke. , 1988, Stroke.

[51]  J. Yudkin,et al.  Determinants of Hospital Admission and Case Fatality in Diabetic Patients With Myocardial Infarction , 1988, Diabetes Care.

[52]  Blood glucose and prognosis of acute stroke. , 1988, Age and ageing.

[53]  P. Mølstad,et al.  Acute myocardial infarction in diabetic patients. , 2009, Acta medica Scandinavica.

[54]  J. Yudkin,et al.  Hyperglycaemia, Diabetes and Myocardial Infarction , 1987, Diabetic Medicine.

[55]  Opie Lh,et al.  Plasma glucose on admission to hospital as a metabolic index of the severity of acute myocardial infarction. , 1986 .

[56]  W. Kannel,et al.  Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. , 1986, American heart journal.

[57]  L. Opie,et al.  Plasma glucose on admission to hospital as a metabolic index of the severity of acute myocardial infarction. , 1986, The Canadian journal of cardiology.

[58]  H. Beck-Nielsen,et al.  Prevalence and Mortality of Acute Myocardial Infarction in Patients with Diabetes , 1985, Diabetes Care.

[59]  R. Beaglehole,et al.  Event, incidence and case fatality rates of cerebrovascular disease in Auckland, New Zealand. , 1984, American journal of epidemiology.

[60]  S. McAlpine,et al.  Prognostic importance of hyperglycaemia induced by stress after myocardial infarction , 1984, British medical journal.

[61]  S. McAlpine,et al.  Prognostic importance of hyperglycaemia induced by stress after acute myocardial infarction. , 1984, British medical journal.

[62]  B. Schulte,et al.  Epidemiology of stroke in Tilburg, the Netherlands. The population‐based stroke incidence register: 2. Incidence, initial clinical picture and medical care, and three‐week case fatality. , 1982, Stroke.

[63]  P A Wolf,et al.  Survival and recurrence following stroke. The Framingham study. , 1982, Stroke.

[64]  A. Krolewski,et al.  Clinical Course of Myocardial Infarction Among Diabetic Patients , 1980, Diabetes Care.

[65]  B. Clarke,et al.  Experience of coronary care in diabetes. , 1976, British medical journal.

[66]  B. Modan,et al.  Acute myocardial infarction. Prognostic value of white blood cell count and blood glucose level. , 1975, JAMA.

[67]  P. McNamara,et al.  Morbidity and Mortality in Diabetics In the Framingham Population: Sixteen Year Follow-up Study , 1974, Diabetes.