Silent myocardial infarction and its prognosis in a community-based cohort of Type 2 diabetic patients: the Fremantle Diabetes Study

Abstract

Aims/hypothesis. Our study investigated the prognosis of Type 2 diabetic patients with silent myocardial infarction in a community-based cohort. Methods. We analysed data from 1269 patients with Type 2 diabetes mellitus from a community-based observational study of diabetes care, control and complications. Silent myocardial infarction was defined as Q waves (Minnesota codes 1.1, 1.2) on a baseline electrocardiogram in the absence of a history or symptoms of CHD. Results. Silent myocardial infarction was present in 3.9% of patients, or 44% of all Q-wave myocardial infarctions. The patients were subdivided into those with (i) no clinical or Q-wave evidence of myocardial infarction (Group 1), (ii) silent myocardial infarction (Group 2), (iii) self-reported CHD but no Q waves (Group 3), and (iv) self-reported CHD and Q waves (Group 4). Compared to Groups 3 and 4, Group 2 patients were more likely to be women, less likely to have smoked, and had higher serum HDL-cholesterol concentrations and higher blood pressure. Over an average of seven years, and after adjusting for other independent predictors of death, all-cause and CHD mortality were similar in Groups 1 and 2 and greater (twofold for all-cause and fourfold for CHD mortality) in Groups 3 and 4. Conclusions/interpretation. Silent myocardial infarction is common in Type 2 diabetes and has a prognosis similar to that in patients without a history of CHD or Q waves. [Diabetologia (2004) 47:395-399]

Vascular depression in older people with diabetes

“…There are a number of clinical implications. Vascular depression is likely to be preventable by intensive cardiovascular risk factor management, but we have demonstrated that treatment of hypertension, dyslipidaemia and hyperglycaemia in our patients is frequently suboptimal [23,41]. Major depression in late life is often recurrent and disabling and requires active management, yet is often undiagnosed and undertreated [43].…”

“…Baseline assessment (1993)(1994)(1995)(1996) At baseline a comprehensive history of diabetes and comorbid conditions was taken, a physical examination was performed and the patients provided fasting blood and urine samples for standard biochemical tests, including serum glucose, HbA 1c , serum lipoproteins and albumin : creatinine ratio (ACR) [20][21][22][23]. Complications were identified using standard definitions.…”

“…Selfreported stroke and transient ischaemic attack were amalgamated with prior hospitalisations for these conditions to define baseline cerebrovascular disease (CVD) status. Patients were classified as having CHD if there was a self-reported history of, or hospitalisation for, myocardial infarction, angina, coronary artery bypass grafting, angioplasty and/or definite myocardial infarction on Minnesotacoded ECG [23]. The ankle : brachial index (ABI) was obtained from brachial and ankle systolic blood pressures using Doppler detection, and peripheral arterial disease (PAD) was defined as an ABI ≤0.90 or the presence of a diabetes-related lower-extremity amputation [26].…”

Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study

“…Selfreported stroke and transient ischaemic attack were amalgamated with prior hospitalisations to define baseline cerebrovascular disease (CVD) status. Patients were classified as having CHD if there was a self-reported history of, or hospitalisation for, myocardial infarction, angina, coronary artery bypass grafting, angioplasty, and/or definite myocardial infarction on a Minnesota-coded electrocardiogram [20]. Peripheral arterial disease (PAD) was considered to be present when the ankle brachial index (ABI) was e0.90 (either side) [21].…”

Bone mineral density and its determinants in diabetes: the Fremantle Diabetes Study

“…Self-reported stroke and transient ischaemic attack were amalgamated with prior hospitalisations to define baseline cerebrovascular disease status [23]. Patients were classified as having CHD if there was a self-reported history of, or hospitalisation for, myocardial infarction, angina, coronary artery bypass grafting, angioplasty, and/or definite myocardial infarction on a Minnesota-coded electrocardiogram [25].…”