Incidence and predictors of silent myocardial infarction in type 2 diabetes and the effect of fenofibrate: an analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

Burgess, David; Hunt, David; Li, Liping; Zannino, Diana; Williamson, Elizabeth; Davis, Timothy; Laakso, Markku; Kesäniemi, Y. Antero; Zhang, Jun; Sy, Raymond W.; Lehto, Seppo; Mann, Stewart; Keech, Anthony

doi:10.1093/eurheartj/ehp377

Cited by 101 publications

(61 citation statements)

References 29 publications

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“…7 Baseline risk factors were similar for patients with silent and clinical MI in FIELD, but characteristics of patients with SMI but no history of cardiovascular disease were not assessed. The 58 placebo-treated patients with SMI at 2 years had a prognosis over the next 3 to 4 years similar to that of the 79 patients who had experienced a clinical MI by 2 years, 7 but this may have been influenced by the at least one third with known cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…8 In FIELD, 1.3% of patients with an ECG assessment at 2 years had SMI. 7 In the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes (RECORD) study, the prevalence of unrecognized Q-wave MI was 1.9% at baseline. 21 This inconsistency may be explained by different features of the patients in the UKPDS compared with the other studies and/or changes in CHD screening, diagnosis, and management over time.…”

Section: Discussionmentioning

confidence: 99%

“…In placebo-treated patients recruited to the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial, those with SMI identified 2 years into follow-up had subsequent coronary heart disease (CHD) and all-cause mortality over the next 3 years similar to those who had suffered a clinical MI during the first 2 years on study. 7 In contrast, patients in the community-based observational Fremantle Diabetes Study (FDS) with SMI at study entry had significantly lower subsequent CHD and all-cause mortality over 7 years than patients with known CHD at baseline. 8 These discrepant results may reflect differences between the selected FIELD patient cohort and the more community-representative FDS patients such as in demographic characteristics, risk factor profiles, use of cardiovascular therapies, and duration of follow-up, as well as in categorization of patients and methods of analysis.…”

Section: Editorial See P 965 Clinical Perspective On P 987mentioning

confidence: 99%

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Prognostic Significance of Silent Myocardial Infarction in Newly Diagnosed Type 2 Diabetes Mellitus

2013

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Background-We aimed to determine the prevalence of silent myocardial infarction (SMI) in people with newly diagnosed type 2 diabetes mellitus and its relationships to future myocardial infarction (MI) and all-cause mortality. Methods and Results-We examined data from the 5102 patients in the 30-year UK Prospective Diabetes Study (UKPDS) and used Cox proportional hazards regression to examine outcomes by SMI status. Of 1967 patients with complete baseline data, 326 (16.6%) had ECG evidence of SMI (Minnesota codes 1.1 or 1.2) at enrollment. Those with SMI were more likely to be older, female, sedentary, and nonsmokers compared with those without SMI. Their mean blood pressure was greater despite more intensive antihypertensive treatment; they were more likely to be taking aspirin and lipid-lowering therapy; and they had a greater prevalence of microangiopathy. Fully adjusted hazard ratios for those with versus those without SMI in multivariate models that included UKPDS Risk Engine variables were 1.58 (95% confidence interval, 1.22-2.05) for fatal MI and 1.31 (95% confidence interval,1.10-1.56) for all-cause mortality. Hazard ratios for first fatal or nonfatal MI and for first nonfatal MI were nonsignificant. The net reclassification index showed no improvement when SMI was added to these models, and the integrated discrimination index showed that SMI marginally improved the prediction of fatal MI and all-cause mortality. Conclusions-About 1 in 6 UKPDS patients with newly diagnosed type 2 diabetes mellitus had evidence of SMI, which was independently associated with an increased risk of fatal MI and all-cause mortality. Davis et al Silent Myocardial Infarction in Type 2 Diabetes Mellitus 981The UK Prospective Diabetes Study (UKPDS) 9 affords the opportunity to assess the prognostic importance of SMI in newly diagnosed T2DM patients without significant comorbidities who were followed up over a longer period than in other studies. We have examined the prevalence of SMI in UKPDS participants at enrollment, its correlates, and its relationship with subsequent clinically evident MI and death. Methods PatientsFull details of UKPDS participants have been published. 10 Briefly, 5102 of 7616 people referred by their general practitioners with newly diagnosed T2DM were enrolled. Exclusion criteria included severe vascular disease, MI or stroke within the previous year, and major systemic illness. The study received ethical committee approval in each of the 23 UK clinical centers and conformed to the Declaration of Helsinki guidelines. All patients gave informed consent before participation. Study DesignThe UKPDS protocol has been reported in detail.9,10 Briefly, enrolled patients underwent baseline assessment and then after a 3-to 4-month dietary run-in period before allocation to diet (if fasting plasma glucose <15 mmol/L), sulfonylurea, insulin, or, if >120% ideal body weight, metformin therapy. All patients were seen quarterly in UKPDS clinics for a median within-trial follow-up to the end of September 1997 of 10 year...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Editorial See P 965 Clinical Perspective On P 987mentioning

confidence: 99%

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Prognostic Significance of Silent Myocardial Infarction in Newly Diagnosed Type 2 Diabetes Mellitus

2013

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“…Several studies in diabetic patients assessed serial ECGs over several years and found overall a low incidence of silent MI detected by Q waves, although they accounted for up to one third of all MIs identified (symptomatic and asymptomatic; Table 2). 10,[12][13][14][15] The studies are discordant on the question of whether a silent MI is associated with a significantly increased risk of future cardiovascular events.…”

Section: Article See P 980mentioning

confidence: 99%

Prevalence, Incidence, and Implications of Silent Myocardial Infarctions in Patients With Diabetes Mellitus

Scirica

2013

Circulation

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“…52 Fenofibrate also reduced the number of subsequent CV events in patients who had a previous asymptomatic or 'silent' MI (RRR 78%; p = 0.003). 53 The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study investigated the effects on CVD outcomes of intensive control of blood glucose, BP or plasma lipids in three separate study arms. In the ACCORD lipid study arm, simvastatin monotherapy was compared with simvastatin plus fenofibrate (starting dose 160 mg/day) in patients with type 2 diabetes, 37% of whom had experienced a previous CVevent.…”

Section: Fenofibratementioning

confidence: 99%

Statins and beyond: Concurrent strategies for prevention of cardiovascular disease in patients with type 2 diabetes

Standl

2012

Diabetes and Vascular Disease Research

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Diabetes is a significant risk factor for the development of cardiovascular disease (CVD), particularly in the presence of high blood pressure, poor glycaemic control and high total cholesterol. While efforts to control blood pressure or blood glucose beyond levels considered ‘normal’ in patients with diabetes have not produced the expected reduction in CVD, treatment with statins to reduce levels of low-density lipoprotein cholesterol (LDL-C) has been much more successful. However, many patients with diabetes who receive statins (even at high doses) remain at significant residual risk of CVD due to the presence of atherogenic dyslipidaemia. Markers of persisting risk include low levels of high-density lipoprotein cholesterol (HDL-C), high levels of triglycerides (TG) and LDL-C levels above target despite high-dose statin therapy. Combining statins with drugs that target HDL-C and TG, such as fibrates, niacin and omega-3 polyunsaturated fatty acid (PUFA) ethyl esters, may offer further protection from CVD in patients with diabetes.

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Incidence and predictors of silent myocardial infarction in type 2 diabetes and the effect of fenofibrate: an analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

Abstract: Silent and clinical MI have similar risk factors and increase the risk of future CVD events. Fenofibrate reduces the risk of a first MI and substantially reduces the risk of further clinical CVD events after silent MI, supporting its use in type 2 diabetes.

Cited by 101 publications

References 29 publications

Prognostic Significance of Silent Myocardial Infarction in Newly Diagnosed Type 2 Diabetes Mellitus

Prognostic Significance of Silent Myocardial Infarction in Newly Diagnosed Type 2 Diabetes Mellitus

Prevalence, Incidence, and Implications of Silent Myocardial Infarctions in Patients With Diabetes Mellitus

Statins and beyond: Concurrent strategies for prevention of cardiovascular disease in patients with type 2 diabetes

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