Risk of myocardial infarction in men and women with type 2 diabetes in the UK: a cohort study using the General Practice Research Database

Mulnier, Henrietta; Seaman, Helen E.; Raleigh, Veena S; Soedamah‐Muthu, Sabita S.; Colhoun, Helen M.; Lawrenson, Ross; Vries, Corinne S de

doi:10.1007/s00125-008-1076-y

Cited by 64 publications

(41 citation statements)

References 36 publications

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“…Similar to the present study, previous studies have shown that diabetes increases the risk of AMI [3][4][5], with a stronger association in women than in men [4,5], and that the most physically active people with diabetes have approximately half the risk of cardiovascular death compared with inactive people with diabetes [24,25]. Moreover, we have recently shown that physical activity modified the association between diabetes and mortality [26].…”

Section: Discussionsupporting

confidence: 89%

“…Diabetes induces vascular dysfunction that predisposes to atherosclerosis [1,2] and is associated with about a twofold increased risk of acute myocardial infarction (AMI) [3][4][5]. Although a broad-based treatment may improve survival in people with diabetes with existing cardiovascular disease, knowledge of effective means for primary prevention of AMI among people with diabetes is still sparse [6].…”

Section: Introductionmentioning

confidence: 99%

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The adverse association of diabetes with risk of first acute myocardial infarction is modified by physical activity and body mass index: prospective data from the HUNT Study, Norway

et al. 2014

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Aims/hypothesis Diabetes increases the risk of acute myocardial infarction (AMI) and effective means for primary prevention are warranted. We prospectively examined the joint association of diabetes and leisure-time physical activity, as well as of diabetes and BMI, with the risk of AMI. Methods A total of 55,534 men and women in the Norwegian HUNT Study were followed-up for first AMI by hospital admission registries and the Cause of Death Registry. Cox proportional adjusted HRs with 95% CIs were estimated. Results Overall, 1,887 incident AMIs occurred during 12.3 years. Compared with inactive people without diabetes, inactive people with diabetes had an HR of 2.37 (95% CI 1.58, 3.57), whereas the HR among highly active persons with diabetes was 1.04 (95% CI 0.62, 1.74). Normal-weight (BMI 18.5-25 kg/m 2 ) persons with diabetes had an HR of 1.60 (95% CI 1.05, 2.44) and obese (BMI>30 kg/m 2 ) persons with diabetes had an HR of 2.55 (95% CI 1.97, 3.29) compared with normal-weight persons without diabetes. The data suggest biological interaction between diabetes and physical activity, with a relative excess risk of inactivity and diabetes of 1.43 (95% CI 0.08, 2.78). For obesity and diabetes, the excess risk due to interaction was smaller (0.67; 95% CI −0.24, 1.58). Conclusions/interpretation Body weight and, in particular, physical activity modified the association between diabetes and risk of first AMI. This highlights the potential importance of physical activity and weight maintenance in primary prevention of AMI among people with diabetes.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The adverse association of diabetes with risk of first acute myocardial infarction is modified by physical activity and body mass index: prospective data from the HUNT Study, Norway

et al. 2014

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“…Observational studies have generally shown a lesser risk of MI at lower glycemic levels (6,7). However, no population-based real-world studies have evaluated the importance of glycemic control on the development of MI beginning at the diagnosis of diabetes and onward.…”

mentioning

confidence: 99%

Contemporary Risk Estimates of Three HbA1c Variables for Myocardial Infarction in 101,799 Patients Following Diagnosis of Type 2 Diabetes

et al. 2015

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OBJECTIVEThis study evaluated the risk of myocardial infarction (MI) by impaired glycemic control in a contemporary large cohort of patients with type 2 diabetes followed from diagnosis. RESEARCH DESIGN AND METHODSPatients with type 2 diabetes diagnosed between 1995 and 2011 were retrieved from the Clinical Practice Research Datalink in the U.K., and followed from diagnosis until event of MI or end of study in 2013. Two subcohorts were defined: an early cohort with those diagnosed from 1997 to 2004 and a recent cohort with those diagnosed from 2004 to 2011. Association between each of three HbA 1c metrics and MI was estimated using adjusted proportional hazards models. RESULTSIn the overall cohort (n = 101,799), the risk increase for MI per 1% (10 mmol/mol) increase in HbA 1c was higher for updated latest and updated mean HbA 1c of 1.11 (95% CI 1.09-1.13) and 1.15 (1.13-1.18) than for baseline HbA 1c of 1.05 (1.03-1.06). In the early subcohort, the corresponding risk estimates were greater than those in the recent subcohort. When categorized, the updated latest variable showed an increased risk for HbA 1c <6% (42 mmol/mol), relative category 6-7%, in the recent but not in the early subcohort, with hazard ratios of 1.23 (1.08-1.40) and 1.01 (0.84-1.22), respectively. CONCLUSIONSThe two time-updated HbA 1c variables show a stronger relation with MI than baseline HbA 1c . The risk association between HbA 1c and MI has decreased over time. In recently diagnosed patients with type 2 diabetes, an increased risk of MI exists at a current HbA 1c of <6.0% (42 mmol/mol).The global burden of diabetes has risen dramatically during the last two decades and is expected to affect more than 500 million adults worldwide by 2030, with the majority having type 2 diabetes (1). Patients with type 2 diabetes have a shorter lifeexpectancy, and myocardial infarction (MI) is the most common cause of the excess risk of death in these patients (2-4). Studies of glycemia as a risk factor for cardiovascular events have shown somewhat different results. Three large clinical trials,

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“…In general, a two-to fivefold risk of myocardial infarction (MI) exists in T2DM compared with the general population [1]. The relative risk (RR) seems to be higher in women than in men (up to nine and three times, respectively, compared with the general population), although the exact absolute difference in CVD risk between diabetic genders in a given glycemic state is not known [3].…”

Section: Introductionmentioning

confidence: 99%

“…An accumulating body of evidence during the last few decades has established an association between diabetes mellitus [both type 1 (T1DM) and type 2 (T2DM)] and increased risk of cardiovascular disease (CVD) in both genders [1][2][3]. In general, a two-to fivefold risk of myocardial infarction (MI) exists in T2DM compared with the general population [1].…”

Section: Introductionmentioning

confidence: 99%

The effect of antidiabetic medications on the cardiovascular system: a critical appraisal of current data

Anagnostis¹,

Siolos²,

Gkekas³

et al. 2018

Hormones

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Both type 1 and type 2 diabetes are associated with increased risk for cardiovascular disease (CVD) events. This risk seems to be reduced by achievement of euglycemia. However, after the withdrawal of rosiglitazone from the market, the question arose as to whether this risk concerns simply a matter of euglycemia or the distinct role played by each antidiabetic drug with respect to its effect on CVD risk. To address this issue, many studies have been published during the last decade involving old and new antidiabetic agents, which however yielded contradictory results. Briefly, metformin is still considered safe and confers a beneficial effect on CVD risk. Conflicting data exist as concerns sulfonylureas, although the second and third generation representatives are regarded as relatively safe. Pioglitazone use seems to be associated with a reduction in CVD risk, whereas the dipeptidyl-dipeptidase-4 inhibitors (DPP-4i), lixisenatide and exenatide-LAR [from the category of glucagon-like-peptide-1 receptor (GLP-1R) agonists], confer a neutral effect. Two other GLP-1R agonists, liraglutide and semaglutide, as well as the sodium-glucose transporter-2 (SGLT2)-inhibitors, empagliflozin and cangliflozin, have shown an additional effect on CVD risk reduction, although their safety is in doubt. Insulin analogues and newer long-acting compounds are also safe for the cadiovascular system. The aim of this narrative review is to present and critically analyse the current data for each antidiabetic drug category with regard to their effect on CVD risk.

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Risk of myocardial infarction in men and women with type 2 diabetes in the UK: a cohort study using the General Practice Research Database

Cited by 64 publications

References 36 publications

The adverse association of diabetes with risk of first acute myocardial infarction is modified by physical activity and body mass index: prospective data from the HUNT Study, Norway

The adverse association of diabetes with risk of first acute myocardial infarction is modified by physical activity and body mass index: prospective data from the HUNT Study, Norway

Contemporary Risk Estimates of Three HbA1c Variables for Myocardial Infarction in 101,799 Patients Following Diagnosis of Type 2 Diabetes

The effect of antidiabetic medications on the cardiovascular system: a critical appraisal of current data

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