Diabetes is not a risk factor for myocardial infarction in patients without coronary artery disease: A study from the Western Denmark Heart Registry

Abstract

Background: Diabetes is considered a risk factor for myocardial infarction. However, we have previously found that diabetes was not a short-term risk factor for myocardial infarction in the absence of obstructive coronary artery disease. Methods: We conducted a cohort study of patients undergoing coronary angiography from 2003 to 2012 and followed them by cross-linking Danish health registries. Patients were stratified according to coronary artery disease and diabetes. Endpoints included myocardial infarction, cardiac death, all-cause death and coronary revascularization. Results: 86,202 patients were included in total (diabetes: n = 12,652). Median follow-up was 8.8 years. Using patients with neither coronary artery disease nor diabetes as reference (cumulative myocardial infarction incidence 2.6%), the risk of myocardial infarction was low and not substantially increased for patients with diabetes alone (3.2%; hazard ratio 1.202, 95% confidence interval 0.996−1.451), was increased for patients with coronary artery disease alone (9.3%; hazard ratio 2.75, 95% confidence interval 2.52−3.01) and was highest for patients with both coronary artery disease and diabetes (12.3%; hazard ratio 3.79, 95% confidence interval 3.43−4.20). Similar associations were observed for cardiac death and coronary revascularization. Conclusion: Diabetes patients without coronary artery disease by coronary angiography have a low risk of myocardial infarction, not substantially increased compared to patients with neither coronary artery disease nor diabetes. In the presence of coronary artery disease, however, diabetes increases the risk of myocardial infarction.

Coronary Artery Disease Prevalence in Patients Having Essential Hypertension with Or Without Diabetes Mellitus Detected by Cardiac MIBI Scan

“…[6,7] . Diabetes mellitus has been found as an independent risk factor for CAD, irrespective of the fact whether other risk factors are present or absent [8] Our results are similar to those of Lacourciere et al [9] . They conducted MPS in 1116 hypertensive patients without known coronary artery disease (CAD), and found CAD in 28.9% of patients.…”

Impact of diabetes on long-term all-cause re-hospitalization after revascularization with percutaneous coronary intervention

“… 25 It is suggested that interaction between cardiovascular disease and diabetes enhances the risk of micro- and macrovascular complications, such as stroke, peripheral artery disease and kidney failure, which could explain the association with worse outcome. Although patients with diabetes with a coronary angiography without coronary artery disease did not have an increased risk of MI compared to non-diabetic patients, 24 they remained at increased risk of stroke and all-cause death. 25 , 26 Our study supported the implication that diabetic patients with comorbidities continuous to be a high-risk patient group with worse outcome and increased risk of readmission and should be treated with caution and awareness.…”

“…A study by Gyldenkerne et al 24 concluded that diabetic patients with concomitant diabetes and coronary artery disease had a much higher risk of MI and all-cause death compared to non-diabetic patients with coronary artery disease. Patients with diabetes also have a higher risk of stroke even when coronary artery disease is not present.…”

Cardiovascular risk in patients with and without diabetes presenting with chronic coronary syndrome in 2004–2016

“…Anatomical Therapeutic Chemical (ATC) codes used in the Danish Prescription Registry and International Classification of Diseases 10 (ICD-10) codes used in the Danish National Health Registry and the Danish Register of Causes of Death are listed in supplemental material of previous work [ 19 ].…”