The disparity between long-term survival in patients with and without diabetes following a first myocardial infarction did not change between 1989 and 2006: an analysis of 6,776 patients in the Northern Sweden MONICA Study

Eliasson, Mats; Jansson, Jan‐Håkan; Lundblad, Dan; Näslund, Ulf

doi:10.1007/s00125-011-2247-9

Cited by 20 publications

(30 citation statements)

References 18 publications

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“…Our finding of increased case fatality among diabetic stroke patients corroborates two small Danish studies with follow-up periods of 10-12 years [11,12] and two recent reports from the Northern Sweden MONICA study of longterm survival after a first stroke [5] or myocardial infarction [16]. Although limited to patients below the age of 75 years, a stronger impact of diabetes on stroke survival was noted among younger and female patients in the MONICA study.…”

Section: Discussionsupporting

confidence: 90%

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Differences in cardiovascular risk factors and socioeconomic status do not explain the increased risk of death after a first stroke in diabetic patients: results from the Swedish Stroke Register

et al. 2013

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Aims/hypothesis This study compared survival rates and causes of death after stroke in diabetic and non-diabetic patients in Sweden. We hypothesised that differences in cardiovascular risk factors, acute stroke management or socioeconomic status (SES) could explain the higher risk of death after stroke in diabetic patients. Methods The study included 155,806 first-ever stroke patients from the Swedish Stroke Register between 2001 and 2009. Individual patient information on SES was retrieved from Statistics Sweden. Survival was followed until 2010 (532,140 person-years) with a median follow-up time of 35 months. Multiple Cox regression was used to analyse survival adjusting for differences in background characteristics, in-hospital treatment, SES and year of stroke. Causes of death were analysed using cause-specific proportional hazard models. Results The risk of death after stroke increased in diabetic patients (HR 1.28, 95% CI 1.25, 1.31), and this risk was greater in younger patients and in women. Differences in background characteristics, cardiovascular risk factors, inhospital treatment and SES did not explain the increased risk of death after stroke (HR 1.35, 95% CI 1.32, 1.37) after adjustments. Diabetic patients had an increased probability of dying from cerebrovascular disease and even higher probabilities of dying from other circulatory causes and all other causes except cancer. Conclusions/interpretation Differences in cardiovascular risk factors, acute stroke management and SES do not explain the lower survival after stroke in diabetic compared with non-diabetic patients. Diabetic patients are at higher risk of dying from cardiovascular causes and all other causes of death, other than cancer.

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Section: Discussionsupporting

confidence: 90%

“…The decreased survival after stroke in patients with diabetes is very similar to that after myocardial infarction [16]. As increased mortality is mostly attributable to heart disease, similar mechanisms probably apply after the initial event of both stroke and myocardial infarction.…”

Section: Discussionmentioning

confidence: 74%

Differences in cardiovascular risk factors and socioeconomic status do not explain the increased risk of death after a first stroke in diabetic patients: results from the Swedish Stroke Register

et al. 2013

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“…In recent years however, the management of patients with MI has improved significantly and one important question is to know to what extent diabetic patients may have benefited from these advances when compared to non-diabetic patients. Although this question has previously been addressed, the results have not been concordant in all studies [7][8][9][10][11][12][13]. In the present paper, we present a systematic review and metaregression of temporal trends in the excess mortality associated with DM after MI.…”

Section: Introductionmentioning

confidence: 61%

“…There were 252 studies on the impact of diabetes mellitus on mortality after MI or ACS for which a detailed assessment of the full-text was performed. We finally included 110 studies [1,2,[7][8][9][10]. The reasons for exclusion were: studies not reporting number and crude all-cause mortality rates of diabetic vs. nondiabetic patients (n = 23), studies not focusing on MI/ACS (n = 4), studies in which diabetic patients were matched with non-diabetic patients (n = 8), studies focusing on MI patients in cardiogenic shock (n = 5), studies not reporting the inclusion period (n = 5), studies with an inclusion period N5 years (n = 42), studies not reporting early or 6-12 months year mortality (n = 16), and studies with overlapping data (n = 39).…”

Section: Search Results and Study Selectionmentioning

confidence: 99%

A systematic review and meta-regression of temporal trends in the excess mortality associated with diabetes mellitus after myocardial infarction

Bauters

Lemesle

Groote

et al. 2016

International Journal of Cardiology

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“…Hence, in addition to a higher risk of stroke, younger women with diabetes seem to have a worse prognosis after stroke. Interestingly, a recent study showed almost identical trends and disparities in long-term survival after a first myocardial infarction among diabetic subjects within the Northern Sweden MONICA study [21], implying common pathways not reversed by traditional risk factor treatment.…”

Section: Discussionmentioning

confidence: 99%

The Disparity in Long-Term Survival after a First Stroke in Patients with and without Diabetes Persists: The Northern Sweden MONICA Study

Eriksson¹,

Carlberg

Eliasson

2012

Cerebrovasc Dis

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Background: Diabetes is an established risk factor for stroke. Compared to nondiabetic patients, diabetic patients also have an increased risk of new vascular events and death after stroke. We analyzed how differences in long-term survival between diabetic and nondiabetic stroke patients have changed over time, and if differences varied with respect to sex and age. Methods: This population-based study included 12,375 first-ever stroke patients, 25–74 years old, who were registered in the Northern Sweden MONICA Stroke Registry 1985–2005. Uniform diagnostic criteria for stroke case ascertainment were used throughout the study period. The diagnosis of diabetes was based on medical records or diabetes diagnosed during the acute stroke event. Patients were separated into four cohorts according to year of stroke and followed for survival until August 30, 2008. Results: The diabetes prevalence at stroke onset was 21%, similar in men and women, and remained stable throughout the study period. The diabetic patients were an average of 2 years older, more often nonsmokers and more likely to have antihypertensive treatment, antithrombotics, atrial fibrillation, and a history of myocardial infarction or transient ischemic attack than the nondiabetic patients. The total follow-up time was 86,086 patient-years during which a total of 1,930 (75.7%) of the diabetic patients and 5,744 (58.5%) of the nondiabetic patients died (p < 0.001). Median survival was 60 months (95% CI: 57–64) in diabetic patients and 117 months (113–120) in the nondiabetic patients. Survival improved significantly in both groups (p < 0.001). A Cox regression, adjusting for possible confounders (age, sex, antihypertensive medication, antithrombotics or other thrombolytic agents, history of myocardial infarction, type of stroke, diabetes, cohort and the diabetes-by-sex, diabetes-by-age and diabetes-by-cohort interactions), showed a hazard ratio of 1.67 (1.58–1.76) comparing survival in diabetic versus nondiabetic patients. The reduced survival in diabetic stroke patients was more pronounced in women (p = 0.02) and younger patients (p < 0.001). There was a tendency that the difference in survival decreased between the earlier cohorts and the 2000–2005 cohort, but the test for interaction did not reach statistical significance (p = 0.08). Conclusion: Long-term survival after a first stroke has improved in both diabetic and nondiabetic patients. Survival is markedly lower in diabetics, especially in women and younger patients, and the disparity persisted over 24 years. Decreasing the disparity in stroke survival is a challenge for stroke and diabetes care. New treatment methods in combination with intense secondary prevention in diabetic patients, especially in younger women, are needed.

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The disparity between long-term survival in patients with and without diabetes following a first myocardial infarction did not change between 1989 and 2006: an analysis of 6,776 patients in the Northern Sweden MONICA Study

Cited by 20 publications

References 18 publications

Differences in cardiovascular risk factors and socioeconomic status do not explain the increased risk of death after a first stroke in diabetic patients: results from the Swedish Stroke Register

Differences in cardiovascular risk factors and socioeconomic status do not explain the increased risk of death after a first stroke in diabetic patients: results from the Swedish Stroke Register

A systematic review and meta-regression of temporal trends in the excess mortality associated with diabetes mellitus after myocardial infarction

The Disparity in Long-Term Survival after a First Stroke in Patients with and without Diabetes Persists: The Northern Sweden MONICA Study

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