Ten-year cardiovascular risk in diabetes patients without obstructive coronary artery disease: a retrospective Western Denmark cohort study

Abstract

Background Diabetes patients without obstructive coronary artery disease as assessed by coronary angiography have a low risk of myocardial infarction, but their myocardial infarction risk may still be higher than the general population. We examined the 10-year risks of myocardial infarction, ischemic stroke, and death in diabetes patients without obstructive coronary artery disease according to coronary angiography, compared to risks in a matched general population cohort. Methods We included all diabetes patients without obstructive coronary artery disease examined by coronary angiography from 2003 to 2016 in Western Denmark. Patients were matched by age and sex with a cohort from the Western Denmark general population without a previous myocardial infarction or coronary revascularization. Outcomes were myocardial infarction, ischemic stroke, and death. Ten-year cumulative incidences were computed. Adjusted hazard ratios (HR) then were computed using stratified Cox regression with the general population as reference. Results We identified 5734 diabetes patients without obstructive coronary artery disease and 28,670 matched individuals from the general population. Median follow-up was 7 years. Diabetes patients without obstructive coronary artery disease had an almost similar 10-year risk of myocardial infarction (3.2% vs 2.9%, adjusted HR 0.93, 95% CI 0.72–1.20) compared to the general population, but had an increased risk of ischemic stroke (5.2% vs 2.2%, adjusted HR 1.87, 95% CI 1.47-2.38) and death (29.6% vs 17.8%, adjusted HR 1.24, 95% CI 1.13–1.36). Conclusions Patients with diabetes and no obstructive coronary artery disease have a 10-year risk of myocardial infarction that is similar to that found in the general population. However, they still remain at increased risk of ischemic stroke and death.

Absence of Coronary Artery Disease is a Strong Negative Predictor of Major Adverse Cardiovascular Events in Patients with Chronic Kidney Disease

“…Our finding is concordant with our previous publications regarding MI in patients with diabetes, 10–13 stroke and limb amputations in patients with diabetes, 14 , 15 and stroke in patients with atrial fibrillation. 16 There is a paucity of studies examining the association between the presence of CAD, kidney function, and cardiovascular risk.…”

“…We have previously shown that the absence of CAD eliminates the excess MI risk in patients with diabetes, 10–13 reduces the excess risk of stroke and limb amputations in patients with diabetes, 14 , 15 and reduces the risk of stroke in patients with atrial fibrillation. 16 In the current study we aimed to investigate if CAD is also a strong negative predictor across different stages of CKD.…”

“…7,8 However, strong associations between impaired kidney function and long-term cardiovascular outcomes (risk of death, heart failure and myocardial infarction (MI)) in patients with CCS were recently reported in a Swedish cohort. 9 We have previously shown that the absence of CAD eliminates the excess MI risk in patients with diabetes, [10][11][12][13] reduces the excess risk of stroke and limb amputations in patients with diabetes, 14,15 and reduces the risk of stroke in patients with atrial fibrillation. 16 In the current study we aimed to investigate if CAD is also a strong negative predictor across different stages of CKD.…”

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

“…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 randomised controlled trial to assess the antithrombotic effects of aspirin in type 1 diabetes: role of dosing and glycaemic control

“…Patients with diabetes mellitus, including type 1 (T1D) or type 2 (T2D), are at increased risk of atherothrombotic events, including acute coronary syndromes, thrombotic stroke and critical limb ischaemia [ 1 , 2 ]. Platelet activation and fibrin network formation are key to the formation of intravascular obstructive thrombus in these conditions [ 3 ].…”