Abstract
Background 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. Methods 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. Results 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). Conclusions 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.
| Original language | English |
|---|---|
| Pages (from-to) | 1273-1281 |
| Number of pages | 12 |
| Journal | European Journal of Preventive Cardiology |
| Volume | 23 |
| Issue number | 12 |
| Early online date | 23 Feb 2016 |
| DOIs | |
| Publication status | Published - Aug 2016 |
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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. / Nedkoff, Lee; Knuiman, Matthew; Hung, Joe; Briffa, Tom G.
In: European Journal of Preventive Cardiology, Vol. 23, No. 12, 08.2016, p. 1273-1281.Research output: Contribution to journal › Article
TY - JOUR
T1 - 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
AU - Nedkoff, Lee
AU - Knuiman, Matthew
AU - Hung, Joe
AU - Briffa, Tom G.
PY - 2016/8
Y1 - 2016/8
N2 - © European Society of Cardiology 2015.Background 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. Methods 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. Results 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). Conclusions 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.
AB - © European Society of Cardiology 2015.Background 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. Methods 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. Results 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). Conclusions 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.
U2 - 10.1177/2047487316634279
DO - 10.1177/2047487316634279
M3 - Article
VL - 23
SP - 1273
EP - 1281
JO - European Journal of Cardiovascular Prevention & Rehabilitation
JF - European Journal of Cardiovascular Prevention & Rehabilitation
SN - 1350-6277
IS - 12
ER -